A Systematic Review to Compare Costs and Outcomes of Pharmacoeconomic Evaluations of Conventional and Biosimilars G-CSFs

Abstract

Introduction: The presence of biosimilars in the field of oncology is regarded as a key approach to attain sustainable healthcare. Granulocyte colony-stimulating factor (G-CSF) is a drug mostly prescribed after chemotherapy to avoid neutropenia. There are several G-CSF biosimilars approved to help reduce the significant economic burden on healthcare stakeholders through cost saving and to increase patient access. To date, no systematic assessment of the pharmacoeconomic evaluation of G-CSF biosimilars has been performed. The aim of this study is to synthesize evidence from economic evaluations (EEs) of G-CSF biosimilars published articles to provide essential data for involved stakeholders and policy makers. Materials and methods: PRISMA-guided systematic searches of PubMed, Scopus and EMBASE databases were conducted. Search was done up to April 2023 using predefined keywords. Articles were screened for relevant publications about EEs of G-CSF biosimilars that were used as prophylactic and or as a treatment for chemotherapy-induced neutropenia (CIN). We included articles for cost-effectiveness analysis (CEA) and budget impact analysis (BIA) Exclusion criteria were case reports, abstracts, letters to the editor, conference presentations, editorials, and studies written in languages other than English and articles of other types of pharmacoeconomic analysis. Risk of bias assessments were undertaken to assess data strength and validity. Results: We identified a total of six EEs studies (one cost-effectiveness analysis, two studies reported both cost-effectiveness and cost-utility analysis and three budget impact analyses). Three studies were from United State (US), two from France and one from Singapore. The six studies met > 80% of the JBI quality assessment criteria. The primary prophylaxis with filgrastim biosimilar in breast cancer, non-small cell lung cancer, and non-Hodgkin lymphoma provided an additional 0.102-0.118 FN event avoided, 0.065-0.144 Lys, 0.057-0.13 QALYs at an incremental cost of 651 US$-2463 US$. The incremental cost effectiveness ratio (ICER) ranged from 5660 US$-20806 US$ per FN event avoided, 5123 US$ - 31077 US$ per LY gained, and 7213 US$ - 35563 US$ per QALY gained. The NSCLC has the lowest ICERs. Conclusions: Evaluated studies showed that G-CSF biosimilars are cost effective compared to the references as primary and secondary prophylaxis for chemotherapy induced neutropenia among oncology patients