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Spain Could Save Millions With Greater Bevacizumab Biosimilar Adoption


If biosimilars are introduced to Spain, they will most likely save money in the pharmacological budget, according to a budget impact analysis model.

The introduction of biosimilars to the Spanish Health System (SNHS) of Spain would create saving costs in the pharmacological budget to promote biological drugs from the first year, according to a study published in the European Journal of Hospital Pharmacy.

This study was conducted to evaluate the economic impact of introducing bevacizumab biosimilars in the systemic treatment of patients with cancer in the SNHS.

“Cancer is the second leading cause of death in Europe and one of the diseases with the greatest impact on public health,” said the researchers.

Bevacizumab was the first approved angiogenesis inhibitor to treat cancer tumors and therefore expanded the line of biological treatments against cancer. It’s estimated that about 30% of the pharmaceutical budget in Europe is set aside for the acquisition of biological drugs. Patent expirations for originator biological drugs has given rise to biosimilar drug alternatives.

First, a 3-year budget impact analysis model was adapted to estimate biosimilar introduction cost of bevacizumab in the SNHS for the adult population eligible to receive bevacizumab treatment. Values for the estimation of the population were acquired through the literature and validated by an expert panel.

Next, in the analysis, only pharmaceutical costs acquired through official databases were considered. A sensitivity analysis was performed to examine the strength of the model.

The launch of bevacizumab biosimilars would produce a yearly cost saving of €11,558,268 ($12,394,104; −5.1%) for the first year with a penetration share of biosimilars from 30%, €29,126,373 ($31,232,647; −8.5%) for the second year with a share of 50% and €52,361,778 ($56,148,320; −13.6%) for the third year with a share of 80%.

The total pharmaceutical costs of the plan without biosimilars are €227,033,352 ($243,451,269) for the first year, €342,663,209 ($367,442,899) for the second year and €385,013,076 ($412,855,297) for the third year. Conversely, the pharmaceutical costs of the plan with bevacizumab biosimilars are €215,475,084 ($231,057,165), €313,536,836 ($336,210,252) and €332,651,297 ($356,706,976) for years 1, 2 and 3, respectively.

Upon examination, a decrease was seen in the costs of all cancers treated with bevacizumab per patient after the introduction of biosimilars. Indications that needed higher doses saw a greater impact because of the lower price of biosimilars with bevacizumab for indications such as metastatic, unresectable or relapsed non-small cell lung cancer (mNSCLC), except for squamous cell histological type, and advanced and/or metastatic renal cell carcinoma, stage 3B. However, for indications where a greater number of patients are treatment candidates for either reference bevacizumab or its biosimilars, such as stage 3C and 4 epithelial ovarian, Fallopian tube or peritoneal cancer and metastatic colorectal cancer (mCRC), showed high-cost differences.

“In the first year, and with a penetration rate of 30.0% for the bevacizumab biosimilars, a savings of 5.1% (−€11,558,268 [$12,394,104]) was estimated. Due to the increase in the market share of bevacizumab biosimilars compared with the original, it was estimated that in years 2 and 3 the budgetary impact would include decreases of 8.5% (−€29,126,373 [$31,232,647]) and 13.6% (−€52,361,778 [$56,148,320]), respectively, in the pharmaceutical costs derived from the treatment of oncological patients with bevacizumab,” said the researchers.

Consequently, the savings are because of the difference in price between original bevacizumab and its biosimilars, to the market access policies for biosimilars, and the confidence of clinicians in their implementation in the hospital setting where demand is greatest.

Even for indications with a lower cost difference between the scenarios, such as mCRC, biosimilars can save €4900 ($5,254) per patient-year, that converts into a decrease in the pharmacological budget because of the large number of patients who can benefit from biosimilar use.

Finally, the absence of certain data in the literature needed for estimating populations who are candidates for treatment with bevacizumab were missing, but the assumptions were validated by participating experts.

“In conclusion, the inclusion of bevacizumab biosimilars in the Spanish healthcare system will lead to a decrease in budget allocations for the acquisition of biological medicines that will be notable after the first year,” said the researchers.


Calleja MA, Albanell J, Aranda E, et al. Budget impact analysis of bevacizumab biosimilars for cancer treatment in adult patients in Spain. Eur J Hosp Pharm. 2023;30(e1):e40-e47. doi:10.1136/ejhpharm-2021-002955

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