Trends and Factors Influencing Biosimilar Utilization for Preventing Febrile Neutropenia in Patients With Cancer

A study published in JAMA Network Open on the utilization trends of granulocyte colony-stimulating factors (G-CSFs) for preventing febrile neutropenia in cancer patients found that the use of G-CSFs increased among high-risk patients, but a significant percentage did not receive preventive treatment.

Guidelines recommend the use of G-CSF to prevent neutropenia in high-risk chemotherapy regimens, but poor adherence to these guidelines has been reported, resulting in potential negative outcomes.

A cross-sectional study was conducted and deemed exempt from review by the University of Florida institutional review board. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies. The study utilized a retrospective, cohort-based design and obtained data from two sources: the MarketScan Commercial and Medicare Supplemental databases, as well as a random national sample of the Medicare fee-for-service claims database. These databases included patient-level enrollment information and information on healthcare utilization.

Participants were adult patients with cancer who initiated chemotherapy between 2014 and 2019, and various inclusion and exclusion criteria were applied to select the study population. G-CSF utilization was assessed, and FN risk factors and patient characteristics were analyzed. Statistical analysis was performed, including descriptive statistics and trend tests. Sensitivity analyses were conducted in subpopulations of commercially insured and Medicare patients. The study was conducted using SAS statistical software between March and June 2021.

A total of 86,731 chemotherapy courses were identified from 82,410 patients in the commercial insurance database. The average age of patients was 57.7 years, with 66.7% being women and 33.3% being men. Similarly, 32,398 chemotherapy courses were identified from 30,279 patients in the Medicare database, with an average age of 71.8 years and 57.0% women and 43.0% men. G-CSF use increased significantly in both populations from 2014 to 2019, with 45.1% to 47.5% of patients in the commercial insurance population and 36.0% to 39.1% of patients in the Medicare population using G-CSFs.

The largest increases in G-CSF use were observed among patients with high FN risk. G-CSF use decreased in the commercially insured population among patients with intermediate or low FN risk, while remaining stable in the Medicare population. Factors associated with increased odds of G-CSF use included older age, receiving a regimen with high FN risk, and a history of neutropenia.

“This cross-sectional study found that utilization of G-CSFs increased among patients with cancer with high FN risk in both a commercially and Medicare-insured population, but 14% to 17% of patients still did not receive preventive treatment,” said researchers.

Reference

Wang C, Heldermon CD, Vouri SM, et al. Trends in use of granulocyte colony-stimulating factor following introduction of biosimilars among adults with cancer and commercial or Medicare insurance from 2014 to 2019. JAMA Netw Open. 2021;4(11):e2133474. doi:10.1001/jamanetworkopen.2021.33474