Priyam Vora, AJMC

A new hospital-wide formulary change resulted in the replacement of filgrastim with TBO-filgrastim for all on- and off-label indications.

A new study comparing the duration of neutropenia in patients after autologous hematopoietic stem cell transplantation (HSCT) finds that there are no significant differences in the results between filgrastim and TBO-filgrastim in a clinical setting. However, TBO-filgrastim offers significant cost savings over filgrastim.  

Filgrastim, a bone marrow stimulant, helps the body make white blood cells after receiving cancer medications. It can also improve survival in people who have been exposed to radiation. While neutropenia is an abnormally low count of a type of white blood cell, myeloma is a type of cancer that originates in the bone marrow.  

Steven Trifilio, along with his fellow researchers, used data from the Northwestern Memorial Hospital electronic database and published the findings in 

Clinical Transplantation: The Journal of Clinical and Translational Research

. They studied 182 patients with myeloma. Out of these, 91 patients had received filgrastim immediately prior to the change and 91 had received TBO-filgrastim afterward. Most patients from both groups received chemotherapy three weeks prior to transplantation.  

Several demographic characteristics such as age, weight, gender, body surface, number of doses per patient, stem cell doses, etc, were studied among patients who received either TBO-filgrastim or filgrastim following stem cell infusion.

There was no significant difference in platelet count at the time of engraftment (Engraftment is when the new blood-forming cells start to grow and make healthy blood stem cells that show up in your blood; it is an important milestone in transplant recovery).  

Although overall time to stem cell engraftment was similar for both groups, early engraftment occurred more often in filgrastim-treated patients. Conversely, documented infections were observed more frequently in TBO- treated patients vs. filgrastim-treated patients.  

Early studies using filgrastim in patients with myeloma treated with autologous HSCT showed lesser duration of neutropenia by as much as 2 weeks. However, filgrastim is expensive. And since transplant recipients typically receive more therapy, some cost saving alternatives could be realized with less-expensive agents. This enables healthcare officials to provide efficacy and safety all at a reduced cost.  

The study shows that TBO-filgrastim is about the same as filgrastim with respect to safety and efficacy. However, the cost-saving potential is manifold in using TBO-filgrastim over filgrastim. For every 480 lm vial, the current cost of TBO-filgrastim is $286.80 as compared to filgrastim that costs $356.39.  

With almost 25% difference between the 2, patients who require 9 TBO-doses versus 8 filgrastim doses would still promote significant cost savings (approximately $400 per patient). Simultaneously, the median length of stay at the hospital was also similar for both study groups.  

“TBO-filgrastim and filgrastim differ in time to engraftment and rates of infection following autologous stem cell transplantation. Whether these results are clinically relevant or significantly impact cost savings remains to be determined in future randomized studies,” the study stated.

This article was originally published on our sister site the American Journal of Managed Care.

Articles

Bone marrow stimulant helps the body make white blood cells after receiving cancer medications. 

TBO-Filgrastim Offers Significant Cost Savings Over Filgrastim in Myeloma Treatment

Nearly half of insured American adults are unaware that they should have an annual medical check-up, according to the results of a survey. They are even ignorant to the fact that their insurance covers the annual check-up and there is no cost out-of-pocket associated with it.

Cigna led the study by conducting a nationwide survey interviewing 1000 people. The participants were between the ages of 25 to 75 years. All had health insurance and were the decision makers of their family.

The results of the survey found that 80% adults do not know their body mass index (BMI), cholesterol, and triglycerides levels. Another shocking revelation was that less than half the Americans know that they can also discuss their dietary habits and exercise regime with their doctors as part of the annual check-up.

In fact, more Americans are up-to-date with their pets’ health issues. For example, 85% of pet owners know when their pet is due for a shot.

A staggering 80% of the female Americans know the frequency of their manicure and pedicure appointments and an equal percentage of the males know the mileage between oil changes.

However, when it comes to health, 45% of Americans are clueless about the benefits of health insurance.

“Annual check-ups are critical to our personal health,” said Isaac Martinez, MD, utilization management medical director at Cigna. “However, many Americans forget they need an annual check-up and many of those who know, don’t go. That’s why we want people to ‘know, go, and take control’ when it comes to their health.”

The survey also found that just 50% of Americans know their blood pressure and more than 80% do not know that obesity and depression screening is part of their annual check-up.

 that Americans use preventive services at only about half the recommended rate, despite insurance covering most of these costs.

The CDC preventive care data encourages more adults to be aware of the vaccinations and immunizations covered in the annual check-up. Insured adults are also encouraged to take this as an opportunity to discuss healthy eating, exercise and lifestyle habits with their health care providers. Currently, 33% say they visit their health care professionals—but only when a specific health problem arises.

Annual check-ups count as preventive care. It is the easiest way to help prevent illnesses and diseases, and to detect illnesses at an early stage. Making healthy lifestyle choices by discussing them with your health care provider increases the chances of better treatment. If every American takes preemptive action about his health, as many as 100,000 lives could be saved annually, according to the CDC.

American adults largely ignorant that insurance covers annual check-ups and there is no cost out-of-pocket associated with it.

Nearly Half of American Adults Clueless About Their Annual Health Check-Up

A new study finds that Medicare recipients can prevent hospital admissions if they seek medical assessment from clinical home visits, which increase the number of visits to the doctors while reducing the costs of health care because of treatment in less-costly sites.

Soeren Mattke, senior scientist at Rand Corporation, led the new 

 along with Dan Han, Asa Wilks, and Elizabeth Sloss. The study used quantitative and qualitative data from patients enrolled in the HouseCalls program operated by UnitedHealth Group’s information and technology-enabled health services business, Optum.

Under this program, a physician or nurse practitioner visits the Medicare recipient’s home and conducts an exhaustive geriatric assessment of their health. They also provide referrals to community providers and health plan resources to address any pending issues.

The team studied the experiences of the Medicare beneficiaries eligible for the HouseCalls program from 2008 through 2012. The scope of the study was spread across Arkansas, Georgia, Missouri, South Carolina, and Texas.

A majority of the Medicare recipients included in the study were 65 years old and were likely to have multiple chronic conditions in 2010. The beneficiaries also had troubles receiving primary care, either because of financial issues or social. This eventually would have increased the chances of their symptoms worsening resulting in emergency room visits, hospitalizations, and nursing home admissions.

The experiences of these beneficiaries were compared to other Medicare recipients enrolled both in traditional fee-for-service Medicare plans and in Medicare Advantage plans without this benefit.

The team observed that sending a physician or nurse practitioner to a Medicare recipient's home for a comprehensive health assessment resulted in fewer admissions to hospitals or nursing homes over the subsequent year. It also reduced the cost of getting admitted or being treated in hospitals that have their own costs associated.

When compared to other Medicare recipients enrolled in traditional fee-for-service health programs, the Medicare recipients enrolled in the clinical home visit program had 14% fewer hospital admissions in the next year. They even projected a lower risk of admission to nursing homes over the 12 months after evaluation.

The participants experienced an increase in their visits to the physicians and specialists. This increase to physicians was from 2% to 6% in the subsequent year after the evaluation. The program’s effects on the emergency department use was mixed and hence, inconclusive.

“We found that a home visiting program can lead to meaningful cuts in the amount of in-patient care used by Medicare patients,” said Mattke. “This is significant since many other strategies to reduce in-patient care among Medicare recipients generally have been unsuccessful.”

The findings of the study largely propose that a comprehensive health assessment provided at the beneficiary’s home encourages physician office visits and anticipates future illnesses that could result in costly institutional care.

The positive combination of the home environment coupled with the referral services is a promising approach to supporting aging in place. It also avoids hospital admissions, which could increase the cost of health care for the Medicare beneficiary.

Under this program, a physician or nurse practitioner visits the Medicare recipient