Budget Impact Analysis Shows a Need for Deep Discounts for Biosimilar Infliximab

Although the use biosimilar infliximab in rheumatoid diseases and inflammatory bowel disease has the potential to reduce the treatment costs, a variety of factors may influence the adoption of biosimilar treatments and their potential impacts on healthcare budgets.
The Center for Biosimilars Staff
August 15, 2017
Although the use biosimilar infliximab in rheumatoid diseases and inflammatory bowel disease has the potential to reduce the treatment costs, a variety of factors may influence the adoption of biosimilar treatments and their potential impacts on healthcare budgets. A recently published budget impact analysis funded by Hospira evaluated the impact of adopting biosimilar infliximab for the treatment of rheumatoid arthritis (RA), ankylosing spondylitis (AS), Crohn’s disease (CD), and ulcerative colitis (UC) in the United Kingdom (UK), Germany, France, Spain, and Italy (the EU5) in the context of other other available biologics, including reference infliximab and other innovator biologics.

The researchers updated an existing budget impact model to include all currently available biological drugs in the EU5 for the treatment of RA, AS, CD, and UC. The model was informed by epidemiological parameters derived from published literature reviewed in July 2015, and market shares of biologics were derived from data provided by Therapy Watch for the years 2012 and 2013. Three types of costs were included in the analysis: annual acquisition costs, administration costs, and therapy monitoring costs. In the base case analysis, existing patients were assumed to remain on an existing biologic treatment or switch to a biosimilar, while naïve patients could be allocated to any available biologic, including biosimilar infliximab. Price discounts for biosimilar infliximab compared with the reference were based on national list prices: 10% (UK), 14% (Germany), 0% (France), 18% (Spain), and 25% (Italy). The time horizon of the model was 5 years, from 2015 to 2020.

A total of 35 leading rheumatologists and gastroenterologists from the EU5 participated in the first round of a 2015 Delphi survey. Of that group, 17 agreed to participate in a second round of the survey. The panel was asked to forecast the uptake of biosimilar infliximab and estimate the proportion of patients eligible for a particular type of biological treatment. The survey respondents indicated that they believed the efficacy and safety of biosimilar infliximab was comparable with that of the reference in rheumatology and gastroenterology indications. Scenarios considered by the panel were the following:
  • A biosimilar infliximab available at a 50% discount to the reference
  • A biosimilar infliximab available at a 75% discount to the reference
  • Availability of clinical and observational study evidence confirming efficacy and safety of biosimilar infliximab in extrapolated indications (CD and UC)
  • Availability of vedolizumab for the treatment of CD and UC
  • Availability of a biosimilar etanercept for the treatment of RA and AS
  • Availability of a rituximab biosimilar for the treatment of RA


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