Researchers Predict Substantial Savings for Europe on the Strength of Biosimilar Adalimumab

Biosimilar adalimumab entered the European marketplace in October 2018, and since then, all eyes among biosimilar stakeholders have been on countries that have been transitioning to cost-saving biosimilar options from the brand-name Humira.

During the ISPOR 2019 annual meeting, teams of investigators presented data estimating just how much healthcare systems could save by adopting biosimilar adalimumab for all indications of its reference in adult patients. The results highlighted both the scale of potential savings and the variability among European nations.

Germany

First, in an assessment of how the German market would be impacted by biosimilar adalimumab from a Statutory Health Insurance perspective, a cost-minimization model was used to estimate cost savings over a 1-year time horizon.¹

The researchers found that, assuming the market reverted to biosimilar pricing, introducing biosimilar adalimumab could save €373 million (US $416 million) over 1 year.

At 30%, 40%, 50%, 60%, and 70% biosimilar uptake, Germany could save €112 million (US $125 million), €149 million (US $166 million), €186 million (US $207 million), €224 million (US $250 million), and €261 million (US $291 million), respectively.

France

Another study that focused on the French market used a budget impact model to estimate cost savings over various time frames from the payer’s perspective.² The scenario was developed for biosimilar-versus-reference price comparisons with a total market share of 80% at the discounted prices. Adalimumab pricing was modeled for linear uptake at 6, 12, and 24 months, with 20%, 30%, and 40% discounts, as well as an immediate switch of 80% of available market volume.

The researchers found that immediate conversion to discounted biosimilars could generate savings of €35.5 million (US $40 million), €53.3 million (US $59 million), and €71 million (US $79 million) over 24 months.

Linear conversion could generate savings of €18.5 million (US $21 million), €27.7 (US $31 million), and €37 million (US $41 million) over the same period of time.

Belgium

A budget impact model was used to estimate cost savings of adalimumab biosimilars versus the reference in Belgium over a 1- and 2-year time horizon from the payer’s perspective.⁴

Modeled scenarios ere developed for the biosimilar at 2 discounted prices—20% and 30%—and the cost saving opportunity with an immediate transition of 30% to 40% of the market. Uptake was assumed to be linear.

Adoption over a 1- and 2-year timeframe, with resulting market shares of 16% and 22% at the end of each, could result in savings of €15 million (US $17 million), €20.5 million (US $23 million), €20 million (US $22 million) and €27 million (US $30 million) respectively.

An immediate switch of 30% and 40% of the market at 20% and 30% price discounts could generate savings of €14 million (US $26 million), €19 million (US $21 million), €21 million (US $23 million), and €28 million (US $31 million) respectively.

Spain

For the Spanish market, a budget impact model was used to estimate the cost-saving potential of the biosimilar versus the reference over a 1- and 2-year time horizon from the payer’s perspective.⁵

Modeled scenarios were developed for 2 discounted prices—30% and 40%—and the cost-saving potential of an immediate transition of 30% to 40% of the Spanish market. Again, uptake was assumed to be linear.

Adoption over a 1- and 2-year time frame, with resulting market share of 16% and 22%, could result in savings of €15 million (US $17 million), €20.5 million (US $23 million), €20 million (US $22 million), and €27 million (US $30 million) respectively.

An immediate switch of 30% and 40% of the market at 30% and 40% price discounts could release potential savings of approximately €29 million (US $32 million), €38.6 million (US $43 million), €38.6m (US $43 million), and €51.4 million (US $57 million) respectively.

Italy

A budget impact model was used to estimate cost savings of adalimumab biosimilars in Italy over a 30-year time horizon from the payer’s perspective.⁶

Biosimilar adoption at the end of year 1 was modeled to be 5%, which was then assumed to rise to 40% in year 2, with a final market share of 70% in year 3. Discounts were expected to be 50% initially, with erosion of 47% of the year 1 price in year 2, and 33% erosion of the year 2 price in year 3.

Total budget savings projected under this model were €324 million (US $361 million) over 3 years.

United Kingdom

Finally, a pair of studies assessed the impact of biosimilar adalimumab on the United Kingdom’s health system.

First, a budget impact model was used to estimate the cost savings of biosimilar adalimumab over a 1-year time horizon from a regional payer’s perspective.⁶ Uptake was assumed to be 80% by 12 months, and the population treated was assumed to remain constant for the 12-month period.

The investigators found that, at 3, 6, and 12 months, savings could achieve £229 million (US $291 million), £200 million (US $254) and £186 million (US $236 million) in the modelled scenario respectively with recognized market discounting.

These savings could generate an additional 25,000, 21,800 and 20,300 patient-years of adalimumab treatment, or pay mid-point salaries of an additional 6000, 5400, or 5000 nurses for the healthcare system.

Second, a study sought to determine the overall potential 12-month savings opportunity when accounting for drug acquisition cost savings and operational costs in a theoretical UK transition program.⁷

The simulated program was based on a cohort of 250 patients with a total annual use of 6500 units of the reference adalimumab. Operational costs per patient for the transition were assumed to be £62.40 (US $79.39).

Reference adalimumab was assumed to have no discounting off its current list price, while biosimilars were assumed to have discounts of 50% and 65%.

At a 50% discount and a 65% discount, the health system could save £1.14 million (US $1.45 million) and £1.49 million (US $1.90 million), respectively, and costs for the transition would be approximately £15,600 (US $19,847).

References

1. Roehrer W, Waker M, Levysohn A, Bodin M, Keady S. Evaluation of the cost savings potential of introducing an adalimumab biosimilar for the treatment of all licensed adult adalimumab indications in Germany. Presented at: International Society for Pharmacoeconomics and Outcomes Research 24th Annual International Meeting; May 18-22, 2019; New Orleans, Louisiana. Abstract PBI5.

2. Waker M, Levysohn A, Bodin M, Keady S. Evaluation of the cost savings potential of introducing an adalimumab biosimilar for the treatment of all licensed adult adalimumab indications in France. Presented at: International Society for Pharmacoeconomics and Outcomes Research 24th Annual International Meeting; May 18-22, 2019; New Orleans, Louisiana. Abstract PBI6.

3. Waker M, Levysohn A, Bodin M, Keady S. Evaluation of the cost savings potential of introducing an adalimumab biosimilar for the treatment of all licensed adult adalimumab indications in Belgium. Presented at: International Society for Pharmacoeconomics and Outcomes Research 24th Annual International Meeting; May 18-22, 2019; New Orleans, Louisiana. Abstract PBI7.

4. Garbado G, Waker M, Levysohn A, Bodin M, Keady S. Evaluation of the cost savings potential of introducing an adalimumab biosimilar for the treatment of all licensed adult adalimumab indications in Spain. Presented at: International Society for Pharmacoeconomics and Outcomes Research 24th Annual International Meeting; May 18-22, 2019; New Orleans, Louisiana. Abstract PBI21.

5. Gargioli M, Waker M, Levysohn A, Bodin M, Keady S. Evaluation of the cost savings potential of introducing an adalimumab biosimilar for the treatment of all licensed adult adalimumab indications in Italy. Presented at: International Society for Pharmacoeconomics and Outcomes Research 24th Annual International Meeting; May 18-22, 2019; New Orleans, Louisiana. Abstract PBI22.

6. Aubrey P, Waker M, Levysohn A, Bodin M, Keady S. Evaluation of the cost savings potential of introducing an adalimumab biosimilar for the treatment of all licensed adult adalimumab indications in the UK. Presented at: International Society for Pharmacoeconomics and Outcomes Research 24th Annual International Meeting; May 18-22, 2019; New Orleans, Louisiana. Abstract PBI20.

7. Waker M, Levysohn A, Bodin M, Keady S. Cost saving opportunity to a health-system adalimumab biosimilar transition programme account within the UK. Presented at: International Society for Pharmacoeconomics and Outcomes Research 24th Annual International Meeting; May 18-22, 2019; New Orleans, Louisiana. Abstract PBI8.