Biosimilar Beats Subcutaneous Rituximab on Cost Savings in NHL

The launch of biosimilar rituximab is an eagerly awaited event among US healthcare stakeholders who are cognizant of the high cost of intravenously (IV) administered rituximab in treating non-Hodgkin lymphoma (NHL). At the same time, another innovation in rituximab delivery—a subcutaneously administered rituximab formulation—has the potential to save both cost and time.

During the 60th American Society of Hematology Annual Meeting and Exposition in San Diego, California, researchers presented findings from a time-and-cost simulation of subcutaneous rituximab (Rituxan Hycela), brand-name IV rituximab (Rituxan), and biosimilar IV rituximab from the US payer perspective. The simulation analysis was performed for 1 patient with NHL over the course of 6 cycles of treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) using either standard or rapid infusion times.

The investigators derived costs of the subcutaneous and the IV reference rituximab products from first-quarter 2018 average sales prices and 2018 reimbursement rates as listed in the Current Procedural Terminology code set. Costs for the proposed biosimilar were estimated at 15% to 35% discounts to the reference IV rituximab.

The investigators found that, following the first cycle of IV reference rituximab, switching to the subcutaneous formulation saves 650, 720, and 791 minutes (for patients with small, average, and large body sizes, respectively) over the next 5 cycles compared with continuing to use an intravenous option.

Costs for 6 cycles of R-CHOP, assuming a switch from the IV reference rituximab to the subcutaneous presentation at cycle 2, were $54 higher than rapid infusion but $104 lower than the standard infusion of the IV reference for patients with small body size. For patients with medium body size, the cost of subcutaneous administration was $3854 and $4012 lower than the cost of rapid and standard IV administration. For patients with large body size, the subcutaneous product saved $7762 and $7920 versus the 2 IV infusion speeds.

However, compared with an IV biosimilar rituximab, the subcutaneous option was costlier. For patients with small body size, the subcutaneous formulation cost $3647 to $8649 more versus standard infusion and $3805 to $8807 more versus rapid infusion of the biosimilar. For patients with medium body size, these ranges were $325 to $6109 and $484 to $6267 for the 2 infusion speeds. For patients with large body size, at a biosimilar discount of 25% or greater, subcutaneous administration cost at least $286 more at a standard infusion rate, and at a discount of at least 24%, at least $116 more than the biosimilar delivered by rapid infusion.

The researchers concluded that, while subcutaneous rituximab in R-CHOP saves on both time and cost versus using the reference IV rituximab, using a biosimilar IV rituximab saves on costs versus subcutaneous administration in small and average-sized patients at all levels of biosimilar discount, and in large patients if discounted by 25% and 24%.

In an email to The Center for Biosimilars^®, the research team said that, while further investigation is warranted to better evaluate whether these time and cost savings can be achieved in clinical practice, “We believe in the value of simulation models to advance our understanding of the potential time- and cost-savings for different formulations of oncology biosimilars. Further real-world evidence is essential in helping assess how biosimilars may help enable access to medicines for patients who may not otherwise afford them.”

“What we can say,” added the authors, “is that biosimilar medicines are the future of healthcare, providing vital treatments for prevalent, chronic cancer conditions. And, biosimilars deliver the same efficacy and safety that patients and physicians trust and rely upon from reference biologics.”

Reference

McBride A, Balu S, Campbell K, MacDonald K, Abraham I. Subcutaneous versus intravenous rituximab in non-Hodgkin lymphoma treated with R-CHOP: economic modeling for the US. Presented at the 60th Annual Meeting and Exposition of the American Society of Hematology; December 1-4, 2018; San Diego, California. Abstract 4776. ash.confex.com/ash/2018/webprogram/Paper113283.html.