Biosimilars are generally cheaper than originator biologics and may also incite price reductions of originator biologics; however, the benefit of biosimilars is not limited to cost savings. |
Competition in European off-patent biologics and biosimilar markets may expand access to the treatment, improve cost effectiveness of the treatment, increase the number of healthcare professionals, and stimulate an incremental therapeutic innovation. |
1 Introduction
2 Methods
3 Results
Benefit | Study no. | Year/setting | Scope of the study relevant to benefit of BioS | Study design | Result |
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Cost savings from BioS | 1 | Year: 2015 Setting: EU G5 countriesa | Estimate the economic impact by converting originator (Neupogen®) to BioS (Zarzio®) filgrastim for the treatment of chemotherapy-induced febrile neutropenia [21] | Simulation study on hypothetical panel of 10,000 patients/14-day treatment regimen | Cost saving from €3.9 million on day – 4 to €13 million on day – 14, assuming 100% conversion of patients from originator to BioS filgrastim. Other scenarios in this study showed a similar outcome |
2 | Year: 2017 Setting: 28 European countries | Estimate cost savings by introducing rituximab BioS (CT-P10) for patients with rheumatoid arthritis and cancer diagnoses [22] | Budget impact analysis (1–3 years) | Cost saving calculated on drug ranged from €90 million to €570 million. The study explored 3 scenarios | |
3 | Year: 2012 Setting: EU G5 countriesa | Estimate cost savings by converting originator (Neupogen®) to BioS (Zarzio®) and pegylated (Neulasta®) filgrastim for the treatment of chemotherapy-induced febrile neutropenia in patients across all tumor types. Cumulative costs of Neupogen® and Zarzio® were compared with the cost of a single dose of Neulasta® [23] | Simulation study/14-day treatment regimen | Cost saving calculated for treatment with Zarzio® over Neupogen® and Neulasta® was €457.84 and €78.50 | |
4 | Year: 2015 Setting: 5 European countries (Germany, UK, Italy, Netherlands, and Belgium) | Estimate cost savings by converting originator infliximab (Remicade®) to BioS (Remsima®), assuming BioS discount ranges between 10% and 30% of originator price [24] | Budget impact analysis (1 year) | Cumulative cost savings between €25.79 million and €77.37 million across 6 licensed indications. Both naive (50%) and switch (25%) patients were included in the analysis | |
5 | Year: 2014 Setting: EU G5 countriesa | Estimate cost saving by replacing originator (Eprex®) ESA with BioS (Binocrit®) [25] | Simulation study on hypothetical panel of 100,000 cancer patients with chemotherapy-induced anemia | Total estimated saving was €110.5 million and €146.1 million in 100% conversion from originator to BioS, under fixed and weight-based dosing scenarios, respectively. Variations in dosing schemes and treatment scenarios show similar cost savings | |
6 | Year: 2015 Setting: UK, teaching hospital | Estimate cost saving by introducing BioS infliximab for treating patients with IBD [26] | Case study (1 year) | Cost saving of approximately €516,000 in 1 year | |
7 | Year: 2017 Setting: EU G5 countriesa | Study factors influencing the adoption of BioS infliximab in rheumatology and IBD in 6 different scenarios [28] | Budget impact analysis (5 years) | In scenario analyses, the market entry of BioS etanercept and BioS rituximab was also considered. Over a time horizon of 5 years, the rheumatology budget decreased in Germany, Italy, Spain, and the UK. The budget for IBD fell in Italy and Spain but increased in Germany and the UK due to the availability of a new biologic, vedolizumab. Savings increased when BioS infliximab discounts grew to 75% and when BioS etanercept and BioS rituximab were introduced | |
8 | Year: 2018 Setting: Spain, tertiary hospital | Study cost savings from the uptake of new drugs, anti-TNF-α BioS, and therapeutic optimization for treating patients with spondyloarthritis [27] | Retrospective, observational study (2009–2016) | Cumulative cost saving of €798,614 in 2016. Original biologics, new biologics, and BioS incited economic competition such as a lower list price, official discounts, and negotiated rebates. Discounts varied for each drug, reaching a maximum of 31.9% for BioS infliximab. These factors effectively reduced the annual cost per drug per patient | |
Improvement in cost effectiveness of treatment | 9 | Year: 2018 Setting: 9 European countries | Cost effectiveness of biologic therapy compared with standard care [30] | Cost-effectiveness study (5 years) | Use of BioS infliximab therapy was most cost effective, with the highest level of clinical evidence. Cost-effectiveness ratio calculation was repeated by decreasing the price of infliximab by 30%, which resulted in an ICER decrease in the range of 19–30% |
10 | Year: 2015 Setting: EU countries | Cost effectiveness of originator biologic trastuzumab was reviewed for a first-line innovative therapy for metastatic breast cancer in the EU [31] | Cost-effectiveness study of originator biologic trastuzumab | 30% decrease in price of trastuzumab originator and uptake of BioS at this price can make this therapy cost effective by decreasing the ICER value from €63,137 to €147,320 (per QALY, per life-year gained) to €29,520 to €68,880 | |
11 | Year: 2016 Setting: NICE guidelines | Update of treatment guideline in UK following introduction of BioS infliximab [32] | Clinical guidelines in the UK | Adult patients with non-radiographic axial spondyloarthritis can be treated with infliximab. Earlier this indication was restricted for originator infliximab (Remicade®) due to high cost | |
12 | Year: 2014 Setting: NICE guidelines | Update of treatment guideline for the treatment of anemia with ESA [33] | Clinical guidelines in UK | Use of BioS epoetin alfa for cancer patients with chemotherapy-induced anemia was most cost effective (£19,429 per QALY gained) | |
13 | Year: 2016 Setting: EU, IMS Institute report | Strategic health authorities in the UK reassessed the existing guidelines relating to the use of G-CSF medicines [34] | Clinical guidelines updated | Improvement in the cost effectiveness of BioS filgrastim vs. alternative treatment. G-CSF was moved to first-line cancer treatment | |
Increase in patient access to pharmacological treatment | 4 | Year: 2015 Setting: 5 European countries (Germany, UK, Italy, Netherlands, and Belgium) | Estimate additional number of patients treated by cost savings incurred by the use of infliximab BioS (Remsima®) across 6 licensed indications [24] | Budget impact analysis (1 year) | Average budget saving of €43.13 million, which could be used to treat 3900 additional patients with BioS, thereby increasing patient access to TNF-α therapy |
2 | Year: 2017 Setting: 28 European countries | Estimate additional number of patients with rheumatoid arthritis and cancer diagnosis who could be treated by the cost savings from rituximab BioS (CT-P10) under different scenarios [22] | Budget impact analysis (1–3 years) | Savings in drug costs associated with uptake of the rituximab BioS would allow treatment of an additional 7531–47,695 patients, depending on the scenario | |
1 | Year: 2015 Setting: EU G5 countriesa | Estimate number of patients with malignant tumors accessing therapeutic innovations (rituximab and trastuzumab therapies) [21] | Simulation study on hypothetical panel of 10,000 patients/14-day treatment regimen | Total conversion of patients from originator to BioS filgrastim can generate cost savings of €3.9–13 million (day 4 to day 14), which could be reallocated to treat an additional 347–1213 B cell NHL patients with rituximab therapy or an additional 132–461 breast cancer patients with trastuzumab therapy | |
5 | Year: 2014 Setting: EU G5 countriesa | Estimate number of additional patients who could access therapeutic innovation (rituximab for B cell NHL, bevacizumab for metastatic colorectal cancer, and trastuzumab for metastatic HER2-positive breast cancer) by cost savings gained by converting the use of originator with BioS ESA (Binocrit®) in anemic cancer patients [25] | Simulation study on hypothetical panel of 100,000 cancer patients with chemotherapy-induced anemia | Estimated cost savings of €146.1 million could be translated into an additional 12,913 rituximab, 5171 bevacizumab, or 4908 trastuzumab treatments for patients with B cell NHL, metastatic colorectal cancer, and metastatic HER2-positive breast cancer, respectively | |
14 | Year: 2014 Setting: Sweden, southern healthcare region | Change in prescribing guideline | Requirement to obtain an agreement of 3 physicians to initiate biologic treatment for febrile neutropenia was no longer required and individual physician has right to start treatment with the filgrastim BioS | ||
Increase in number of healthcare professionals | 6 | Year: 2018 Setting: Belgium, hospital | Estimate increase in nursing staff by reallocating funds as a result of cost savings generated by the use of BioS infliximab [26] | Case study (1 year) | Cost saving by switching originator to BioS infliximab for treating patients with IBD was diverted to employ a part-time nurse and a full-time nurse to support patients in the hospital |
15 | Year: 2017 Setting: UK, university hospital | Undertake a “managed switching programme” in 143 patients with IBD. Patients treated with originator infliximab were switched to BioS infliximab CT-P13, which generated cost savings used to hire extra healthcare staff [37] | “Managed switching programme” using a gain-share agreement between the NHS hospital trust and clinician group in UK | By investing 12% of the gross savings, 7 IBD specialist nurses, 0.5 WTE clerical support staff, 0.2 WTE pharmacists, and 0.2 WTE dieticians were employed to undertake patient education relating to the switch to BioS drug, risk management plan (e.g., robust pharmacovigilance and drug traceability procedures) to address potential risk due to switching drug, and secondary patient support services. Gain-sharing and incentivizing healthcare professionals from the cost saving as a result of the reduced drug acquisition cost improved health care resource allocation, resulting in a better service and higher quality of patient care | |
Incremental innovation of biologics | 16 | Year: 2018 Setting: Netherlands, hospital pharmacy and oncology day care unit | Enrol 126 patients from 6 hospitals and compare societal costs between the IV and SC formulations of originator trastuzumab (Herceptin®) and rituximab (MabThera®) [38] | Innovation in formulation of off-patent biologics between IV and SC administration | Results indicated that total costs of one administration of SC trastuzumab were 5% lower than those of IV trastuzumab. One administration of SC rituximab was 8% less expensive than IV rituximab, both at list prices |