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Price Variation in Economic Evaluations of Infliximab Could Influence Biosimilar Access


A recent systematic review looked at the impact of different prices for infliximab in inflammatory bowel disease and the willingness-to-pay threshold around the world.

In recent years, Canada and other countries that require justifications for high-priced biologics have begun to shift patients to lower-cost biosimilars, known as nonmedical switching. Biosimilars for infliximab, used in inflammatory bowel disease (IBD), which encompasses Crohn disease (CD) and ulcerative colitis (UC), have become increasingly available.

The inclusion of biosimilars in economic evaluations for pricing decisions has been lacking, but researchers writing in MDM Policy & Access said that examining biologic drug price in a sensitivity analysis provided insight into the cost-effectiveness of biosimilar alternatives.

The authors screened studies using databases such as MEDLINE, Embase, Healthstar, Allied and Complementary Medicine, and more; economic assessments of infliximab for adult or pediatric CD and/or UC published from 1998 through 2019 where drug price was varied in sensitivity analysis were included. Eligible studies could include originator infliximab, biosimilar infliximab, or both, either as an exclusive comparator or used with other therapies; only economic evaluations that contained a 1-way sensitivity analysis of price could be included.

Researchers included each jurisidction’s stated willingness-to-pay threshold for the cost-effectiveness of infliximab.

Out of 844 studies screened, 31 were analyzed. Most studies (58%) showed an incremental cost-effectiveness of infliximab in gastrointestinal diseases that surpassed the WTP threshold.

However, infliximab showed favorable cost-effectiveness at a price ranging from C$66 (US$49) to C$1260 (US$930.13 per vial, depending on the location.

In many other countries, drugs are assessed for their therapeutic benefit relative to existing products, and depending on the outcome of that assessment, price ceilings are set accordingly.

But mandatory switching policies ordering the use of lower cost biosimilars in patients with IBD have incited worries for patients who prefer the original biologic.

The researchers of the current study said alternative pricing strategies and treatment access could be considered to allow patients with IBD to continue access to their current medications.


Bashir NS, Hughes A, Ungar WJ. Infliximab pricing in international economic evaluations in inflammatory bowel disease to inform biologic and biosimilar access policies: a systematic review. MDM Policy & Practice. Published online February 24, 2023.

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