Tony Hagen is senior managing editor for The Center for Biosimilars®.
A study funded by AbbVie finds support for maintaining patients on originator rheumatic agents, such as Humira (adalimumab), rather than switching to biosimilars.
Investigators in Quebec, Canada, say they have found significant costs associated with nonmedical switching (NMS) from originator products to biosimilars in patients with rheumatic conditions. The findings were presented at Virtual ISPOR 2021.
Although the direct costs of switching from an originator to a biosimilar are expected to be lower, given the relatively high costs of originator brands, switching is accompanied by costs of patient evaluations, lab tests and X-rays, additional time spent by health care professionals on education, documentation, hospitalization, emergency department use, workplace productivity loss, and other societal and health care resource utilizations (HCRCs) .
“The true economic impact of originator-to-biosimilar NMS requires the assessment of the difference in costs related to HCRU in addition to those related to the originator and biosimilar drugs themselves,” authors of the study wrote.
The emergence of the study has potential significance for Quebec as it has just announced intentions to begin switching most patients from originator biologics to biosimilars with an anticipated savings of US $83 million by 2022. Although the study evaluated HCRU in patients with rheumatic disease, it did not disclose the originator and biosimilar agents included in the analysis.
The study was funded by AbbVie and conducted in part by researchers from AbbVie Canada and from Peripharm, a company that consults with AbbVie and receives AbbVie funding. AbbVie manufactures the adalimumab originator (Humira), indicated for the treatment of rheumatic diseases and ulcerative colitis, and has much at stake in the mandatory switch from originator biologics to biosimilars currently underway in Quebec and 3 other Canadian provinces.
The study findings were reported in Canadian dollars and converted to US dollars for this article. According to results of the study, nonswitchers were associated with HCRU-related costs over a 6-month period of $435 vs $1036 for switchers. Nonswitchers were associated with societal costs over a 6-month period of $1024 vs $1509 for switchers. The total HCRU and societal costs were $1423 vs $2545 for nonswitchers vs switchers, the authors said.
“A patient undergoing an originator-to-biosimilar NMS will incur an additional $1087 over a 6-month period in comparison to patients who remain on the originator,” they said.
Investigators said the main drivers of the difference in costs between those who remained on originators vs those who switched were hospitalization and productivity loss, “with added costs of $465 and $297, respectively, for patients undergoing an originator to biosimilar NMS,” they said.
Other types of costs bear consideration, such as costs associated with adverse events and government costs of implementing an NMS policy, such as physician paid incentives. “It is possible that patients who undergo an originator-to-biosimilar NMS in Quebec are associated with greater costs than what is reported in the current study,” the authors said.
They drew their data from Quebec sources that included governmental publications. They also cited prior UK and Denmark studies of costs associated with nonmedical switching of patients from originator to biosimilar etanercept, a product that also is used for rheumatic diseases and competes with adalimumab.
In the UK study, investigators used a model based on prior data to estimate costs for hypothetical patients who switched from originator etanercept to 1 of 2 etanercept biosimilars (Benepali and Erelzi). Some were assumed to have switched back to the originator or from one biosimliar to the other. A nonresponder population was included, and it was assumed that some patients switched to other types of biologic agents.
The authors reported “considerable increases in resource use (procedures and visits) for switching vs nonswitching patients,” although annual per patient costs of Benepali and Erelzi were 92% and 90% of the costs of etanercept originator, respectively.
“Nonmedical switching can result in increased costs to health care payers because of increased healthcare resource use following switching; therefore, switching should be a medical decision based on clinical evidence, and driven by physician decision in collaboration with the patient. Further analyses of the impact of nonmedical switching of etanercept in different markets and over longer time periods are required,” the UK study authors wrote.
The Danish investigators (N = 1620) did a 1-year follow-up of a government-imposed switch of patients with rheumatic conditions from originator etanercept to biosimilar (Benepali). Investigators reported modest increases in use (8%) and costs (7%) of outpatient services after switching, “whereas costs of admissions (55%) and medication (5%) decreased.”
“We demonstrated no obvious changes in overall use and costs of health care services following switch from originator to biosimilar etanercept,” the authors wrote.
Mathurin K, Castonguay A, Parison D, et al. Economic impact of originator-to-biosimilar non-medical switching on health care resource utilization in rheumatic patients in Quebec, Canada. Presented at Virtual ISPOR 2021; May 17-20, 2021. Accessed May 19, 2021. https://www.ispor.org/conferences-education/conferences/upcoming-conferences/ispor-2021