Cancer care decision support for WBC growth-factors (GF): Geographic differences in utilization and provider malleability.

128 Background: Growth factor use is the largest single category of drug expenditure for US cancer patients. Oncology Analytics is a decision support company that assists physicians in determining the appropriate use of GF based on the NCCN, ASCO, and ASH guidelines and the level one data that underlies these guidelines. We hypothesized that there would be geographic variation among GF preference and in the malleability of those practice patterns after OA entered a market. We determined the proportion of initial pegfilgrastim requests for preauthorization over other types of GF as well as the review outcomes and final drug of choice after OA intervention of inappropriate GF requests across three specific jurisdictions: Florida, Puerto Rico, Georgia and Texas.

METHODS: We analyzed data from drug preauthorization requests for febrile neutropenia prophylaxis submitted by providers in these four states from 10/01/2013 through 09/30/2015. We tested geographic differences in the preference for pegfilgrastim over other GFs; and in review outcomes and final GF of choice after OA intervention for inappropriate pegfilgrastim requests. Chi-square test and linear regression was employed at 95% CL.

RESULTS: Oncologists in PR are among the most evidence-based of all GF users, preferring to order the more cost-effective filgrastim. Our research indicates that, on average, 2-3 doses of filgrastim are given at a total cost of $600 to $900 per cycle, compared to pegfilgrastim at $3,800 per cycle. GA and TX oncologists, on the other hand, chose pegfilgrastim over other GFs more than their colleagues (70% GA vs. 72% TX vs 60% FL vs 33% PR) but reduced their pegfilgrastim preference substantially in the last two years by 11% and 36% respectively (linear trend, p < 0.05). Filgrastim was the most common replacement of pegfilgrastim across all states.

CONCLUSIONS: There are significant geographic variations in the management of febrile neutropenia. These variations contribute to differences in financial toxicity without clinical benefit. Optimizing growth factor utilization management needs to be focused upon certain locales to be most effective. The impact of GF biosimilars has not yet been evaluated.