Adoption of Biosimilar Infliximab for Rheumatoid Arthritis, Ankylosing Spondylitis, and Inflammatory Bowel Diseases in the EU5: A Budget Impact Analysis Using a Delphi Panel

Abstract

Introduction: Introducing biosimilar infliximab for the treatment in rheumatology (rheumatoid arthritis and ankylosing spondylitis) and inflammatory bowel disease (Crohn's disease and ulcerative colitis) may reduce treatment costs associated with biologics. This study aimed to investigate the budget impact of adopting biosimilar infliximab in five European countries, considering that the budget impact includes the adoption of biosimilar infliximab and the availability of biologic alternatives such as vedolizumab, biosimilar etanercept, biosimilar rituximab, and other relevant factors.Methods: An existing budget impact model was adapted to forecast the budget impact in the UK, Germany, France, Spain, and Italy. Epidemiological parameters were derived from published literature reviewed in July 2015. Current market shares of biologics were derived from Therapy Watch (2012/2013 data). Respondents in a Delphi panel, conducted in 2015 and consisting of several leading rheumatologists and gastroenterologists from different nationalities, were asked to forecast uptake of biosimilar infliximab and estimate the proportion of patients eligible for a particular type of biological treatment, including biosimilar infliximab. Scenario analyses assessed the influence of various factors, including price reductions, on the budget.Results: Uptake of biosimilar infliximab was particularly expected for naïve patients; switching patients that already received other biologics was not expected much. Market shares after 5 years of biosimilar infliximab were ~2% in rheumatology in all five countries and in gastroenterology ranged from 4% in France to over 30% in Italy. Except for France, budgets were expected to decrease for rheumatologic diseases. For gastroenterology, budgets were expected to decrease in Spain and Italy. Budgets were expected to increase substantially in the UK and Germany, due to the introduction of vedolizumab in the studied period. In France, budget was expected to slightly increase for ankylosing spondylitis, Crohn's Disease, and ulcerative collitis. Savings in budget were expected in all countries, for all diseases, when larger price discounts on biosimilar infliximab were used.Discussion and Conclusion: This study has shown that only when price reductions are large enough (i.e., 50% or more), physicians indicated that they will prescribe biosimilars. Policy makers should ensure substantial price reductions and stimulate physicians to use biosimilar products, to obtain savings in healthcare budgets.

Identifying Key Benefits in European Off-Patent Biologics and Biosimilar Markets: It is Not Only About Price!

“…A Spanish study computed actual savings accruing from competition between the reference, biosimilar, and new anti-tumor necrosis factor (TNF)-α products, and from therapeutic optimization [27]. All of these studies pointed to substantial savings in pharmaceutical costs, except for one study in which the budget increased when a new, alternative biologic entered the market during the time horizon of the budget impact analysis [28].…”

The effect of new biosimilars in rheumatology and gastroenterology specialities on UK healthcare budgets: Results of a budget impact analysis

“…Several BIAs assessing the impact of the introduction of infliximab and etanercept biosimilars were found in the literature [17][18][19][20][21][22][23][24][25]. As these BIAs were conducted in different countries in Europe, the total spending on bDMARDs and bDMAIDs varies between countries and the comparisons between international budgets would be inappropriate.…”

“…A survey of the literature revealed that budget impact analyses have been performed to estimate cost savings associated with the entry of infliximab and etanercept biosimilars before and after their market entry at national and international levels [16][17][18][19][20][21][22][23][24][25]. The majority of these budget impact analyses were based on third-party payer perspective (public health systems, payers, patients, and healthcare professionals).…”

Fri0414 secukinumab Provides Rapid and Significant Improvement in the Signs and Symptoms of Ankylosing Spondylitis: Primary (16-Week) Results From a Phase 3 China-Centric Study, Measure 5

“…1 Liudan Tu 1 , Qiujing Wei 1 , Ya Xie 1 , Guixiu Shi 2 , Huaxiang Liu 3 , Qingchun Huang 4 , Jian Wu 5 , Zhenchun Zhang 6 , Shuangyan Cao 1 , Jieruo Gu 1 . 1 the Third Affiliated Hospital of SUN YAT-SEN University, Guangzhou, China; 2 the First Affiliated Hospital of Xiamen University, Xiamen, China; 3 QILU Hospital of Shandong University, Shandong, China; 4 Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China; 5 the First Affiliated Hospital of SOOCHOW University, Suzhou, China; 6 Linyi City People Hospital, Shandong, China Background: Adalimumab has been proved to be effective and safety in management of ankylosing spondylitis (AS) in several clinical trials. In China, small proportion of AS patients had ever used TNF inhibitors and most of them discontinued because of expensive cost.…”