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Study Shows No Increase in Healthcare Utilization After a Nonmedical Switch to a Biosimilar


Six months after patients switched from reference infliximab to biosimilar infliximab, there was no meaningful increase in patients’ outpatient healthcare use, according to a new study.

While switching medically stable patients from reference biologics to cheaper biosimilars has the potential to generate significant cost savings for health systems, some recent studies have suggested that these nonmedical switches could actually lead to higher costs because of increased healthcare utilization.

A study published this month in RMD Open sought to examine whether a large, mandatory nonmedical switch to a biosimilar in Danish patients with inflammatory arthritis changed their resource utilization, and found that, 6 months after switching, there was no meaningful increase in patients’ outpatient healthcare use.

In May 2015, Danish national guidelines mandated a switch from reference infliximab, Remicade, to biosimilar CT-P13 (sold as Inflectra in the United States and as Remsima in other territories) in order to benefit from the 36% lower cost of the biosimilar. The DANBIO registry, which collects clinical information among all Danish patients with inflammatory diseases, offered a chance for investigators to assess healthcare utilization 6 months pre- and 6 months postswitch.

The study population included 769 patients with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis who switched from the reference to the biosimilar infliximab in 2016. The patients had a total of 2995 visits to healthcare providers in the 6 months before switching, 689 visits on the date of switching, and 3034 visits up to 6 months after the switch. In total, 19,752 services (such as consultation, guidance, administration of infliximab or methotrexate, observation, and similar services) were provided to patients, 2019 of which were provided on the switch date. The weekly rate of visits per patient was stable during the full time period investigated.

The total number of days with services provided in the preswitch period was 4131, and in the postswitch period, 4400. Rates of services provided declined after switching, but there was an increase in telephone consultation, patient guidance, intravenous medication, clinical investigation and controls, and patient observation. However, the numerical differences in services provided were close to zero.

The authors concluded that their study showed no evidence of increased outpatient healthcare utilization following the nationwide switch.

“It is reassuring that we found only minor changes in the use of healthcare resources, despite the switch being mandatory and that no specific strategy for patient information was set up,” and they indicated that “the fact that patients were informed about the switch at an already scheduled appointment could potentially reduce the nocebo effect.”


Glintborg B, Sørensen, Hetland ML. Does a mandatory non-medical switch from originator to biosimilar infliximab lead to increased use of outpatient healthcare resources? A register-based study in patients with inflammatory arthritis. RMD Open. 2018;4(2): e000710. doi: 10.1136/rmdopen-2018-000710.

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