This week, a study from Spain retrospectively compared direct costs of intravenous and subcutaneous reference rituximab in the setting of lymphoma, taking into consideration drug costs, pharmacy costs, and chair time-related costs at a single center in 2017. They also conducted the same analysis using the costs of biosimilar rituximab.
This month, the United States saw its first rituximab biosimilar become available for the treatment of chronic lymphocytic leukemia and non-Hodgkin lymphoma. While the launch was greeted with excitement, some have questioned whether the 10% list price discount for the biosimilar, Truxima, is adequate to drive uptake, especially given the fact that other biosimilars (for different reference products) are now entering the US marketplace at discounts approaching 40%.
As the brand-name rituximab, Rituxan, is also available in a subcutaneously administered formulation that reduced chair time and administration costs, questions remain about how willing providers will be to adopt the intravenously (IV) delivered biosimilar.
This week, a study from Spain, where biosimilar rituximab is already available, retrospectively compared direct costs of IV and subcutaneous reference rituximab in the setting of lymphoma, taking into consideration drug costs, pharmacy costs, and chair time-related costs at a single center in 2017.
Using pharmacy department data, as well as economic data from hospital management software, the research team found that, in 2017, 103 patients with lymphoma received 141 IV cycles of rituximab and 386 cycles of subcutaneous rituximab. The brand-name rituximab cost the hospital €1056.85 (US $1170.19) per vial for IV use and €1334.77 (US $1477.92) per vial for subcutaneous use. The median cost per IV cycle was €1458.45 (US $1614.86), making it more expensive than the fixed-dose subcutaneous formulation to acquire.
Once preparation and facilities use were included in the cost analysis, each IV cycle cost a median of €1955.94 (US $2166.89) versus a fixed cost of €1460.01 (US $1617.47) per cycle of the subcutaneous formulation, for a median savings of €495.93 (US $549.42) per cycle with use of the subcutaneous route of administration.
Testing the same analysis using the costs of biosimilar rituximab, which is available to the hospital at a 15% discount for a savings of €163.77 (US $181.43) per cycle, the authors write that it would be necessary for the price of the IV biosimilar rituximab to be 34% lower than the price of subcutaneous rituximab in order to achieve the same cost as the subcutaneous option.
The authors also note that, though this study did not consider patient preferences, in other studies, 80% to 83% of patients stated a preference for subcutaneous administration because of shorter time, more comfortable administration, and a reduced emotional burden related to receiving their treatment.
“Biosimilars represent an important way to save in healthcare management,” write the authors, noting that “They provide sustainability and must have the support of both private and public administrations. However, they add, “Our study demonstrates an important potential annual saving[s]…using [subcutaneous] rituximab when compared to infusing IV rituximab, [and] this saving still remains even when considering the new IV biosimilar.”
Sánchez DO, Gutiérrez A, do Pazo F, et al. Comparative cost analysis of intravenous and subcutaneous administration of rituximab in lymphoma patients [published online November 18, 2019]. Clinicoecon Outcomes Res. doi: 10.2147/CEOR.S212257.