More Savings Are Possible for Oncology Care Model, ASCO Study Says

A real-world study of patients with breast cancer who received febrile neutropenia prophylaxis with biosimilar pegfilgrastim (Udenyca) or reference pegfilgrastim (Neulasta) has not only demonstrated comparable efficacy between the 2 products but also shown that large-scale comparisons of this nature can be done, according to a study presented at ASCO20 Virtual, the annual meeting of the American Society of Clinical Oncology.

Investigators said the study was driven in part by the ongoing efforts by CMS to spur advances in value-based care, particularly through the Oncology Care Model (OCM) and its follow-on, the Oncology Care First Model.

“We have learned through the [OCM] that there are savings to be found by reducing inpatient admissions and emergency department visits and controlling for things such as duplicate [laboratory tests]. However, it has become increasingly clear that further savings will require practices to evaluate their use of both cancer-directed therapy and supportive therapy,” they wrote.

Pegfilgrastim is typically used to stem the incidence of neutropenia, which is a common adverse event for patients undergoing chemotherapy. Pegfilgrastim expense amounts to 5.3% of the total cost of cancer care in the OCM, so trimming this expense via use of biosimilars has great potential for savings.

Study Design

Investigators used the Integra Connect Value Monitor to perform the comparative effectiveness research at scale. This enabled them to perform a matched cohort analysis of patients with breast cancer receiving biosimilar vs reference forms of pegfilgrastim between January 1, 2017, and August 31, 2019. Patients were matched according to age, gender, OCM participation status, and date of treatment. Each biosimilar patient (n = 496) was matched to 5 Neulasta patients.

The rate of neutropenia was the efficacy end point, and neutropenia was defined as patients having an absolute neutrophil count (ANC) less than 1500 or the presence of an ICD-10 code to classify neutropenia in the patient’s medical record.

The rates of neutropenia demonstrated by the biosimilar and reference product were similar at 28.6% and 29.1%, respectively (P = .82).

“These rates are likely higher than those reported in the literature due to the very broad definition of neutropenia used in this study. Follow up will include neutropenia rates by grade,” including grade IV neutropenia (ANC < 500), investigators said.

In an additional study presented at this year’s ASCO meeting, investigators said that use of biosimilar pegfilgrastim in the OCM enabled them to reverse the upward trend in the cost of pegfilgrastim use. The rate was increasing at $292 per year and the biosimilar use from mid-2018 until mid-2019 contributed to a cost decline of $93 over the first year.

For more biosimilar news from ASCO20 Virtual, click here.

Reference

Webster J, Scott JA, Smith H. Udenyca has equivalent efficacy to the pegfilgrastim originator in breast cancer patients receiving highly myelosuppressive chemotherapy. Presented at: ASCO20 Virtual; May 30-31, 2020. Abstract e19273. meetinglibrary.asco.org/record/190539/abstract