Clinical Advance in the Management of Febrile Neutropenia

In the October 2017 Perspectives in Febrile Neutropenia supplement to The American Journal of Managed Care®, Table 2 in the article entitled “Guidelines in the Management of Febrile Neutropenia for Clinical Practice” (page 11) misstated information regarding the Multinational Association of Supportive Care in Cancer (MASCC) febrile neutropenia risk index.

Febrile neutropenia (FN) is among the most serious clinical complications in patients with cancer who are undergoing chemotherapy. Patients with neutropenia, or low neutrophil counts, are predisposed to serious and life-threatening infections because of their immune system’s impaired ability to mount inflammatory responses to bacteria, fungi, and yeast.1,2 Because fever is often the only sign of infection in these patients, the presence of both fever and neutropenia must be treated as a medical emergency.2,3 Despite advances in treatment and prevention, mortality rates in patients with cancer and FN can range from 5% to 20%. Higher mortality rates are associated with patients who have higher occurrences of infectious complications and more comorbidities.3 Although there are slightly varying definitions of FN, most clinical guidelines follow the definitions set forth by the Infectious Diseases Society of America (IDSA).4,5 The IDSA defines fever as a single oral temperature ≥38.3°C (101°F) or a temperature ≥38.0°C (100.4°F) lasting more than 1 hour, and defines neutropenia as an absolute neutrophil count (ANC)

Annual spending on biologic medications has been on the rise. It is estimated that biologic drugs, defined as complex, protein-based, large-molecule compounds designed to treat complicated disease states, accounted for $200 billion to $210 billion of global spending on medicines in 2016.1,2 With such rises in healthcare spending, it is important to consider the economic implications and potential of adopting effective cost-saving measures wherever possible. Biosimilars can offer an opportunity in terms of cost-saving potential, with an estimated potential of $44.2 billion in savings in biologic drug spending in the United States from 2014 to 2024.3 The cost savings could ultimately provide huge benefits to patients, healthcare providers, and all payers involved in the healthcare system, which is especially important in an era of rapidly rising healthcare costs.3 A biosimilar is a biological product that is approved for use based on chemical, molecular, and structural similarities to an already approved biological drug, known as the reference drug or originator product.2 According to the FDA, a biosimilar must show no clinically significant differences in its efficacy and safety profile in comparison with its reference product.4 The introduction of biosimilars into the pharmaceutical market has lowered medication costs while also allowing expanded » patient access to new treatments.5 One example in which the economic and facilitative impact of biosimilars can be seen is the granulocyte colony-stimulating factor (G-CSF) market; there were notable changes in the cost and accessibility of the medication class after the introduction of biosimilars.