Preventive Care, Biosimilars Can Ease Costs of Treating Neutropenia

Since their introduction for treatment of neutropenia in the U.S., biosimilars of Neupogen (filgrastim) and Neulasta (pegfilgrastim) have put a significant dent in costs of care. However, treatment of patients with neutropenia, or low white-blood cell count, and febrile neutropenia (FN), which is neutropenia with fever, is exceedingly costly, given that most patients who turn up at the emergency department with these conditions will be hospitalized, according to a report in the journal The Oncologist by Ralph Boccia, M.D., of the Center for Cancer and Blood Disorders in Bethesda, Maryland.

Ralph Boccia

Boccia and his colleagues noted that costs of treating adult patients with neutropenia/FN in hospital settings amounted to $2.3 billion in 2012 alone. Among pediatric patients hospitalized for treatment of FN in 2012, costs totaled $881 million. The average sales price (ASP) for biosimilars of Neupogen has declined more than 50% since these lower cost agents began to be sold in 2015. The ASP for Neulasta has been pushed down over 40% since competing biosimilars entered the US market in 2018.

These lower-cost biologics represent an important means of tackling the high cost of treating neutropenia/FN, Boccia wrote. But also, stronger efforts should be made to keep patients out of hospital by administering timely preventive care, he wrote.

“Use of [granulocyte colony-stimulating factor] biosimilars may improve costs of care and help reduce the burden of neutropenia/FN to health care systems,” he wrote. “This burden may [also] be reduced through efforts to decrease the number and duration of hospital stays via the optimization of outpatient care, efficiency improvements in management processes, development of educational initiatives, and design of risk stratification tools validated in clinical practice.”

Neutropenia is a common risk of myelosuppressive chemotherapy. Reduced neutrophil counts can predispose patients to potentially life-threatening infections, while also forcing doctors to reduce dosage of life-saving chemotherapy treatments.

Risk factors for FN include older age, advanced disease, poor performance status, a history of neutropenia/FN infections, recent surgery, open wounds, and bone marrow involvement. Blood cancers also are associated with higher rates of hospitalization for neutropenia/FN.

Among pediatric patients with cancer who visit emergency departments for neutropenia/FN, 82.3% end up being hospitalized, and the respective figure for patients of any age is 94.0%.

For children, adults, and elderly patients admitted to hospital for FN, the average length of stay is 4.0 to 8.5 days, 5.7 to 9.6 days, and 6.2 to 6.8 days, respectively. These relatively long stays translate into high mean costs for each of these patient groups with neutropenia/FN: up to $65,000 for children, $40,000 for adults, and $15,000 for elderly patients, according to Boccia’s review.

Mortality is another cost associated with hospitalization for treatment of neutropenia/FN. In-hospital mortality for patients admitted with neutropenia/FN can be very high—9.5%, according to a 2006 analysis of 41,779 patient records. For children with cancer who were hospitalized, rates were 0.4% to 3.0%; for adults with solid tumors, 2.6% to 7.0%; and for adults with hematological malignancies, 7.4%.