(B-053) Utilization of pegfilgrastim following health insurance policy interventions: a multi-institutional real-world study in Taiwan

Background: Pegfilgrastim is indicated to prevent and reduce the incidence of chemotherapy-induced neutropenia. Biosimilars pegfilgrastim have been approved and expected to alleviate the financial burden. In Taiwan, the National Health Insurance (NHI) provides different reimbursement criteria and adjusts over time for originator pegfilgrastim and its biosimilars, offering incentives for prescribing the biosimilars. However, real-world evidence regarding the impact of these NHI reimbursement policies in Asia remains limited.

Objectives: To investigate the changes in the prescribing pattern of pegfilgrastim before and after the implementation of pegfilgrastim biosimilar reimbursement policies in Taiwan.

Methods: The study was retrospectively conducted by using Chang Gung Research Database, the largest multi-institutional electronic medical records in Taiwan. Cancer patients who newly received pegfilgrastim, including both the originator and its biosimilars, from January 2023 to December 2024 were included. We specifically focused on the change after fourth quarter of 2023, when a revision to the health insurance policy took place. Quarterly analyses included: 1) characteristics (e.g., sex, age and laboratory data); 2) cancer type; 3) proportion of biosimilar users; 4) proportion of self-pay and NHI reimbursement among pegfilgrastim users. Effectiveness was assessed in two ways: by measuring the duration of grade 4 neutropenia (absolute neutrophil count < 500/mm³) per cycle when using for management, and by determining the incidence of grade 4 neutropenia per cycle when used prophylactically.

Results: The study involved 1504 oncology patients (mean age 55.7 ± 12.9 years; 70.5% female), with breast cancer being the predominant diagnosis (47.9%). After the fourth quarter of 2023, a total of NHI reimbursement accounted for 63.0%, while self-pay made up 37.0%. A significant increase in the use of the biosimilar pegfilgrastim was observed in both categories: from 10% to 84% (P < 0.01) for NHI reimbursement, and from 30% to 71% (P < 0.01) for self-pay. In cycle-based analyses, there were 418 and 1933 cycles for management and prophylaxis, respectively. For management, the mean duration of grade 4 neutropenia was 11.5 days (SD: 6.2). For prophylaxis, the incidence of grade 4 neutropenia was 7.5%.

Conclusions: The findings of this study revealed a significant shift in pegfilgrastim prescribing patterns following NHI policy interventions. The more lenient reimbursement criteria for biosimilars have markedly increased their utilization by physicians in Taiwan. Further large-scale studies are warranted to confirm the real-world effectiveness of the originator pegfilgrastim compared with its biosimilars.