Background: The emergence of biosimilar filgrastim on the Australian market allows for more competitively priced granulocyte colony-stimulating factors. Consequently prophylaxis of chemotherapy induced neutropenia may now have a favourable cost-benefit outcome in a broader range of chemotherapy protocols.
Aim: To evaluate the potential cost savings of reducing febrile neutropenic hospital admissions for breast cancer patients treated with adjuvant TC (docetaxel/cyclophosphamide) chemotherapy.
Method: Statewide public hospital records were analysed for patients receiving TC during the 2014/2015 financial year to estimate the cost of febrile neutropenic admissions in this patient group. This cost was compared to the estimated cost of providing prophylactic biosimilar filgrastim to all patients receiving TC. These calculations used the lowest priced biosimilar filgrastim available through current hospital-drug company contracts.
Results: During the audit period 29 patients received a total of 106 cycles of TC. Three patients received prophylactic pegfilgrastim from the first cycle of TC onwards (total 12 cycles) with no neutropenia occurring in this cohort. Thirteen febrile neutropenic admissions (range 2 to 12 days, mean 5.1 days) occurred for 11 of the 26 remaining patients (42%). Preventing these admissions by providing prophylactic filgrastim for all 26 patients could potentially provide cost savings of $42,000 to $52,000 per annum state wide. Pegfilgrastim and the first patented filgrastim do not have a favourable cost-benefit outcome because of higher drug cost.
Conclusion: Prophylaxis of febrile neutropenia in adjuvant TC breast cancer chemotherapy is likely to result in cost savings by reducing febrile neutropenic admissions when using the lowest priced biosimilar filgrastim available. In the patient cohort audited this cost saving is in the order of 70%. These results are potentially practice changing and merit prospective evaluation.