OBJECTIVES

COVID-19 guideline recommendations suggest to expand the prophylactic use of colony-stimulating factors in patients with cancer with intermediate to high risk for febrile neutropenia (FN). We evaluated the cost-effectiveness of primary prophylaxis (PP) with Sandoz biosimilars filgrastim and pegfilgrastim patients with breast cancer with intermediate risk of FN compared with secondary prophylaxis (SP) in France, Germany, and Austria.

METHODS

A Markov decision analytic model was constructed to evaluate PP versus SP in patients with breast cancer receiving adjuvant doxetaxel therapy over a lifetime horizon. Cost-effectiveness was evaluated over a range of willingness-to-pay (WTP) thresholds for incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analyses evaluated uncertainty.

RESULTS

In France and Austria, Sandoz biosimilar filgrastim PP provided an additional 0.064 QALYs compared to SP, German gains were 0.068 QALYs. Incremental cost per QALY gains were €6,851 (France), €8,971 (Austria), and €27,509 (Germany). In France and Austria, Sandoz biosimilar pegfilgrastim PP provided an additional 0.079 QALYs compared to SP, German gains were 0.084 QALYs. This resulted in incremental cost per QALY gains of €12,369 (France), €10,371 (Austria), and €40,685 (Germany). Probabilistic sensitivity analyses identified that for biosimilar filgrastim, at a WTP threshold of €50,000 per QALY gained, the probability of the cost-effectiveness of PP remained high (100% for France and Austria; 95.9% for Germany). The probabilities for biosimilar pegfilgrastim were 99.8%(France), 100% (Austria), and 73.4% (Germany).

CONCLUSIONS

At a WTP threshold of €50,000, PP with the Sandoz biosimilars filgrastim and pegfilgrastim is cost-effective in patients with breast cancer with intermediate risk for FN receiving adjuvant docetaxel. The model showed that expanding the use of colony-stimulating factors may be valuable in reducing unnecessary health care visits for patients with breast cancer in order to avoid risk of complications because of COVID-19 and should be considered for the indefinite future.