Systematic Literature Review Calls Economic Impact of Switching to Biosimilars "Uncertain"

Biosimilar drugs are intended by their developers to provide a cost-saving alternative to brand-name biologics, and real-world data are becoming more numerous on the savings associated with biosimilars. However, some reports are conflicting with respect to increased healthcare resource utilization or costs related to nonmedical switching. A systematic literature review published this month in Advances in Therapy reported on the impact of nonmedical switching to biosimilars, and it concluded that the full economic impact of switching remains “uncertain.”

In the study, which was funded by AbbVie, maker of the brand-name adalimumab (Humira), researchers conducted a review to identify data on healthcare resource utilization and costs associated with nonmedical switches, and drew upon published material available in PubMed and EMBASE (published between 2008 and 2018), as well as proceedings from major medical conferences (including the American College of Rheumatology, the American Society of Hematology, the American Diabetes Association, and others) from 2014 to 2018.

The researchers arrived at 54 studies, 23 of which were budget impact models, simulations, or cost-calculations studies. Another 26 studies were medical center—based cohort studies, 3 were national database analyses, 1 was an interview study, and 1 was a policy review.

Switches to biosimilar infliximab were the most commonly reported (48%), followed by switches to biosimilar etanercept (22%) and biosimilar granulocyte colony-stimulating factor therapies (9%).

Only 17 of the studies reported real-world costs related to healthcare resource utilization. Among them, 3 were national database studies, 2 of which were conducted in Denmark and 1 of which was conducted in Turkey. All 3 studies reported higher healthcare resource utilization and related costs after a switch.

In the Danish context, patients had more outpatient visits, phone consultations, clinical investigations, guidance, clinical control, and observation in the 6 months after the switch, but the investigators write that the costs associated with these increases were not substantial. In the Turkish context, the researchers write that total healthcare costs rose by 23% per year for patients who switched to a biosimilar.

A total of 48 studies examined nonmedical switching costs, and 32 of them estimated drug costs only, while 10 estimated costs without a specific breakdown. One reported drug costs plus unspecified costs, and 5 estimated nonmedical switching setup and management costs. Only the Turkish study discussed above reported total healthcare costs as well as healthcare resource utilization costs.

Among the studies that reported post-switch drug cost reduction, 18 were simulations and 15 were center-based cohort studies. Drug cost reduction was estimated to range from €164 million (US $185 million) to €879 million (US $993 million) over different sizes of populations and lengths of follow-up.

Among the 5 studies that estimated nonmedical switch setup costs and management costs, 1 study expected cost increases, ranging from €14,088 (US $15,922) to €17,028 (US $19,245) for planning and €7775 (US $8787) to €68,427 (US $77,334) per medical center for management.

An overall cost associated with switching was estimated to be €2358 (US $2665) per patient, including €106 (US $120) for patient selection and contracting, based on a budget impact model from a UK perspective.

A US simulation study reported the estimated short-term cost of €57.48 (US $64.96) per patient for a switch.

“This systematic literature review found that the overall economic impact of biosimilar [nonmedical switching] remains uncertain,” write the investigators. More real-world studies will be necessary, they indicate, to quantify the full economic impact of nonmedical switches over the short and long terms.

Reference

Liu Y, Yang M, Garg V, Wu EQ, Wang J, Skup M. Economic impact of non-medical switching form originator biologics to biosimilars: a systematic literature review [published online June 5, 2019]. Adv Ther. doi: 10.1007/s12325-019-00998-3.