Sweden's Decentralized Healthcare Budgets and Policies Play a Role in Variable Biosimilar Uptake

Nordic countries with highly competitive public tenders are among the markets that have seen the greatest success with adopting biosimilars and reaping their cost-saving rewards. Yet Sweden, unlike its neighbors, has decentralized healthcare budgets and policies in its 21 county councils, and has seen more variable uptake of biosimilars.

As recently explained in a presentation by Gustaf Befrits, MSc, health economist for Stockholm County Council, in Sweden, switching to biosimilars is not actively promoted at a national level, but switching stable patients is not actively discouraged. On the supply side, biosimilars are encouraged through the use of confidential discount agreements; on the demand side, through gain sharing and expanded patient access.

Last week, 2 new investigations were published that described how county-level market dynamics and policies in Sweden influenced the market share of biosimilar infliximab in the hospital setting and biosimilar etanercept in the outpatient setting.

The investigators conducted a literature review on policies in Sweden, and used IQVIA market data on uptake of the 2 biosimilars in different Swedish counties for the period from the second quarter of 2012 to the fourth quarter of 2017. They also interviewed the national pricing and reimbursement agency as well as local experts and an industry representative.

The investigators found that, for biosimilar infliximab, market share varied widely among counties, with the lowest share being 18% and the highest being 96% in 2017. Early uptake of the biosimilar was slow, with increases in market share coinciding with the expiration of contracts with the brand-name infliximab’s manufacturer.

A quantitative analysis showed that 59% of the variability in the market share for the biosimilar could be explained by the relative difference in discounted price between the biosimilar and its reference. Additionally, the presence of key opinion leaders (KOLs) and local guidelines and initiatives also played a role in decisions about adopting a biosimilar.

A review of data on biosimilar etanercept (which was subject to a national managed entry agreement) showed wide variations in market share for the biosimilar, with market share in one county reaching 40% in 2017 and another reaching 82% in the same year. Additionally, biosimilar market shares decreased slightly in the last quarter of 2017 when the maker of the reference etanercept lowered its price.

A qualitative analysis revealed that the choice between biosimilar and reference etanercept rested largely on differences in rebates for the products, the presence of KOLs, local guidelines, finances, and gains sharing agreements. It was also apparent that some counties were reluctant to switch patients based on an increase in administrative workload linked with a switch.

These findings, write the authors, show that counties react differently to deltas in price, and, as in the case of biosimilar infliximab, are impacted by local policy and stakeholder attitudes.

Future research should focus on other European nations, say the authors, in order to understand whether the patterns observed in these 2 investigations are applicable in other healthcare systems.

References

1. Moorkens E, Simoens S, Troein P, Declerck P, Vulto AG, Huys I. Different policy measures and practices between Swedish counties influence market dynamics: part 1—biosimilar and originator infliximab in the hospital setting [published online April 3, 2019]. BioDrugs. doi: 10.1007/s40259-019-00345-6.

2. Moorkens E, Simoens S, Troein P, Declerck P, Vulto AG, Huys I. Different policy measures and practices between Swedish counties influence market dynamics: part 2—biosimilar and originator etanercept in the outpatient setting [published online April 3, 2019]. BioDrugs. doi: 10.1007/s40259-019-00346-5.