Comparative cost efficiency across the European G5 countries of originators and a biosimilar erythropoiesis-stimulating agent to manage chemotherapy-induced anemia in patients with cancer

Objectives: To evaluate the comparative cost efficiency across the European Union G5 countries of the erythropoiesis-stimulating agents (ESAs) epoetin a (originator [Eprex (R)] and biosimilar [Binocrit (R)]; once weekly), epoetin beta (NeoRecormon (R); once weekly), and darbepoetin alpha (Aranesp (R); once weekly or once every 3 weeks) under different scenarios of fixed and weight-based dosing in the management of chemotherapy-induced anemia. Methods: Direct costs of ESA treatment were calculated for one patient with cancer undergoing chemotherapy (six cycles at 3-week intervals) with ESA initiated at week 4 and continued for 15 weeks. Five scenarios were developed under fixed and weight-based dosing: continuous standard dose for 15 weeks; sustained dose escalation to 1.5x or double the standard dose at week 7, continued for 12 weeks; and discontinued dose escalation to 1.5x or double the standard dose at week 7 for a 3-week period, then 9 weeks of standard dose. Results: Under fixed dosing, the average cost of biosimilar epoetin a treatment across scenarios was (sic)4643 (30,000 IU) or (sic)6178 (40,000 IU). Corresponding estimates were (sic)7168 for originator epoetin alpha, (sic)7389 for epoetin beta, (sic)8299 for darbepoetin a once weekly, and (sic)9221 for darbepoetin a once every 3 weeks. Under weight-based dosing, the average cost of biosimilar epoetin a treatment across scenarios was (sic)4726. Corresponding estimates were (sic)5484 for originator epoetin alpha, (sic)5652 for epoetin alpha, and (sic)8465 for both darbepoetin a once weekly and once every three weeks. Conclusion: Managing chemotherapy-induced anemia with biosimilar epoetin a is consistently cost efficient over treatment with originator epoetin alpha, epoetin beta, and darbepoetin a under both fixed and weight-based dosing scenarios.