Comparative Cost-Efficiency Analysis of Trilaciclib, a Novel CDK4/6 Inhibitor, in the Prophylaxis of Chemotherapy-Induced Myelosuppression

Introduction. Trilaciclib (Cosela TM), a first-in-class breakthrough therapy, is a novel kinase CDK4/6 inhibitor that protects multiple hematopoietic lineages simultaneously by transiently arresting hematopoietic stem and progenitor cells (HSPC) in the G1 phase of the cell cycle and thus protecting HSPCs from damage by cytotoxic chemotherapy. Administered intravenously prior to the start of chemotherapy, it proactively delivers multilineage myeloprotection and therefore has the potential to improve the 3 major clinical manifestations of chemotherapy-induced myelosuppression (CIM): neutropenia, anemia, and thrombocytopenia. Trilaciclib was approved by the FDA in February 2021 and included in the NCCN Guidelines® in March 2021 for managing CIM in patients with extensive-stage small cell lung cancer (ES-SCLC) treated with a platinum/etoposide-containing or topotecan-containing regimen. As an alternative to single lineage-specific interventions with biological agents for neutropenia ([peg]filgrastim, ), anemia ([darb]epoetin alfa, alfa), and thrombocytopenia (romiplostim), trilaciclib may offer economic value in the prophylaxis and/or management of these adverse events. Cost-efficiency analysis evaluates the costs of various scenarios of delivering treatments to identify the most efficient cost-structure contributing to the value equation. The objective of this cost-efficiency analysis was to determine the savings (losses) in drug costs of managing 1 patient at risk for concurrent neutropenia and anemia and thrombocytopenia (NAT), neutropenia and anemia (NA), neutropenia and thrombocytopenia (NT), or anemia and thrombocytopenia (AT) with trilaciclib as opposed to any combination of biologicals, including biosimilars. Methods. Drug cost inputs included the wholesale acquisition cost (WAC; per REDBOOK; all agents) and the average sales price (ASP; per Centers for Medicare and Medicaid Services; all agents except trilaciclib as no ASP is available yet). An average cost was calculated for biosimilars. Dosing schedules were based on the maximum possible dose therapy in the NCCN Guidelines®. An Excel model was developed to calculate, for the 4 scenarios of CIM and the 32 WAC and ASP cost inputs across all agents, the drug cost for every possible combination of originator and biosimilar agents for 1 patient. These estimates were compared to the WAC of trilaciclib to determine the differential cost-efficiency of trilaciclib in terms of savings ($) accrued or losses (-