Nonmedical Switches Reduce Treatment Costs, Increase Healthcare Utilization

During the European League Against Rheumatism’s Annual European Congress of Rheumatology, researchers published findings on the economic impacts of nonmedical switching; while 1 study found that switching to biosimilar infliximab brought down costs without sacrificing efficacy or safety, but another raised concerns about increases in overall healthcare utilization.

In an efficacy and cost analysis of a switch from reference infliximab to CT-P13 (Inflectra, Remsima) in a single center in Lisbon, Portugal, a total of 60 patients who were stable on reference infliximab for the treatment of rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis were switched to the biosimilar in 2016.¹

The researchers reported that, during their observation period (median, 261 days), disease activity across patient groups was largely stable. The disease worsened in 3 patients (5%) while 1 patient had a minor adverse event. These 4 patients discontinued treatment with the biosimilar (1 resumed treatment with the reference and the other 3 changed to a different drug).

The switch to the biosimilar in the remaining patients resulted in a 26.4% reduction in the cost of infliximab, say the authors.

In a separate study, however, researchers presented a systematic literature review on the costs associated with nonmedical switching to biosimilars that found that, in the few studies available on the topic, healthcare resource utilization increased after undertaking a nonmedical switch.²

The researchers, all of whom disclose interests in AbbVie, conducted their review by searching for English-language studies in PubMed and Embase over the past decade. They found only 3 studies that reported on costs associated with switching; a single-center, 2-cohort study found that switching was associated, versus remaining on an originator product, with higher inpatient readmission (80% versus 5%; P =.001) surgery rate (29% versus 0%; P =.02), and steroid use (60% versus 8%; P <.001).

Another single-center study reported more patient visits and phone consultations due to injection-site pain among patients who switched, and the third study, based on a national patient registry, found that outpatient visit days increased among those who switched versus those who did not (5.7 days versus 5.4 days; P <.001).

A comprehensive evaluation of the economic consequences of switching, write the authors, should incorporate not savings from lower prices of drugs, but also such factors as healthcare resource utilization in order to arrive at a more robust understanding of the economic impact of switching.

References

1. Valido A, Silva-Dinis J, Saavedra MJ, Bernardo N, Fonseca JE. Efficacy and cost analysis of a systematic switch from originator infliximab to biosimilar CT-P13 in patients with inflammatory arthritis from a single center. Presented at the European League Against Rheumatism’s Annual European Congress of Rheumatology, June 13-16, 2018; Amsterdam, Netherlands. Abstract AB1231. doi: 10.1136/annrheumdis-2018-eular.5844.

2. Liu Y, Garg V, Yang M, Wu EQ, Skup M. Economic impact of non-medical switching from originator biologics to biosimilars—a systematic literature review. Presented at the European League Against Rheumatism’s Annual European Congress of Rheumatology, June 13-16, 2018; Amsterdam, Netherlands. Abstract AB1276. doi: 10.1136/annrheumdis-2018-eular.4975.