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Geat D, Gisondi P, Maurelli M, Puig L, Paul C, Thaçi D, Iversen L, Bellinato F, Girolomoni G. Price variability of TNF-α inhibitor biosimilars among European countries. J Eur Acad Dermatol Venereol 2024; 38:e663-e665. [PMID: 38108512 DOI: 10.1111/jdv.19756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Davide Geat
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
- Spedali Civili Hospital, Brescia, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Martina Maurelli
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carle Paul
- Department of Dermatology, INSERM Infinity, Toulouse University, Toulouse, France
| | - Diamant Thaçi
- Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Chaplin S, van Stiphout J, Chen A, Li E. Budget impact analysis of including biosimilar adalimumab on formulary: A United States payer perspective. J Manag Care Spec Pharm 2024:1-13. [PMID: 39066551 DOI: 10.18553/jmcp.2024.24036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND The biosimilar market is growing rapidly, as evidenced by 41 approvals and 37 launches to date. As adalimumab biosimilars launch in the United States, competition among biosimilar and reference adalimumab will likely increase across multiple reference indications, including rheumatology, dermatology, and gastrointestinal diseases, which may lead to decreased payer costs. OBJECTIVE To evaluate the costs of adding biosimilar adalimumab to a US commercial plan by exploring various utilization and price differential scenarios. METHODS A 3-year budget impact model for a US commercial plan of 1 million people was developed to assess switching from reference adalimumab or any self-injectable reference tumor necrosis factor (TNF) inhibitor to biosimilar adalimumab. Pharmacy and medical costs were analyzed through high- and low-conversion scenarios from reference adalimumab and the TNF inhibitor class. Price reductions of 5% to 60% relative to reference adalimumab based on previous biosimilar launches were also explored. Short-term medical costs were evaluated as additional simple and complex office visits, with scenarios of half of switch patients having 1 visit up to all switch patients having 10 visits. RESULTS In a target population of 1,863 patients, switching from reference adalimumab to biosimilar adalimumab had cumulative cost savings of $5,756,073 with slow conversion (10%-20% over 3 years) and $28,780,365 with fast conversion (50%-100% over 3 years). Similar results were seen when switching from any other self-injectable reference TNF inhibitor. Cost savings more than $1 million were seen with a 10% conversion from reference adalimumab and a 15% price reduction from reference adalimumab. Additional office visit scenarios had a negligible impact on budget, with no changes in per-member-per-month costs until all switch patients had 10 additional complex visits, in which per-member-per-month costs increased by $0.02. CONCLUSIONS In a hypothetical plan of 1 million lives, use of biosimilar adalimumab in commercial plans can lead to significant cost savings for payers because of increased competition. Greater and faster biosimilar conversion rates from reference adalimumab and other reference TNF inhibitors resulted in decreased costs. Additionally, even with short-term medical expenditures, cost savings were still realized when switching to biosimilar adalimumab.
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Stajszczyk M, Obarska I, Jeka S, Batko B. Budget impact analysis and treatment availability with biosimilar TNF inhibitors in rheumatic diseases in Poland: real-world evidence using a nationwide database. Ann Rheum Dis 2023; 82:1171-1180. [PMID: 37328194 PMCID: PMC10423465 DOI: 10.1136/ard-2022-223696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Although several years have passed since biologic disease modifying antirheumatic drugs were introduced to the market, considerable disparities in access still remain. Tumour necrosis factor inhibitors (TNFi) have proven to be highly effective and safe for treating patients with rheumatic musculoskeletal diseases (RMDs). The emergence of biosimilars is promising for cost reduction and more equitable, widespread access. METHODS A retrospective budget impact analysis based on final drug prices was conducted using 12 687 treatment courses for infliximab, etanercept and adalimumab. Estimated and real-life savings for public payer were calculated from an 8-year perspective of TNFi use. Data on the treatment cost and on the evolution in the number of patients treated was provided. RESULTS From a public payer perspective, the estimated total savings amount to over €243 million for TNFi, with over €166 million attributed to treatment cost reduction in RMDs. Real-life savings were calculated as €133 million and €107 million, respectively. The rheumatology sector generated between 68% and 92% of total savings across models, depending on the adopted scenario. The overall decrease in mean annual cost of treatment ranged between 75% and 89% in the study frame. If all budget savings were spent on reimbursement of additional TNFi, a hypothetical total of almost 45 000 patients with RMDs could be treated in 2021. CONCLUSIONS This is the first nation-level analysis that shows estimated and real-life direct cost-savings for TNFi biosimilars. Transparent criteria for reinvesting savings should be developed on both a local and an international levels.
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Affiliation(s)
- Marcin Stajszczyk
- Department of Rheumatology and Autoimmune Diseases, Silesian Center for Rheumatology, Orthopedics and Rehabilitation, Ustroń, Poland
| | | | - Slawomir Jeka
- Clinical Department of Rheumatology and Connective Tissue Disease, Collegium Medicum UMK, University Hospital No. 2, Bydgoszcz, Poland
| | - Bogdan Batko
- Department of Rheumatology and Immunology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Kraków, Poland
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Zaguia F, Randerson EL, Moorthy RS, Goldstein DA. Efficacy of Biosimilar Infliximab-Dyyb in Non-Infectious Uveitis. Ocul Immunol Inflamm 2023:1-5. [PMID: 37582248 DOI: 10.1080/09273948.2023.2244071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 06/26/2023] [Accepted: 07/30/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE To describe the frequency of uveitis recurrences in patients with non-infectious uveitis treated with the biosimilar infliximab-dyyb. DESIGN Retrospective case series. METHODS Records of uveitis patients treated with the biosimilar infliximab-dyyb between 2016 and 2022 at two institutions were reviewed. Data extracted included patient demographics, diagnosis, previous originator infliximab use, additional immunosuppression medications, infliximab-dyyb use, reason for switch, disease activity, and follow-up time. RESULTS A total of 14 patients were identified. Seven patients were switched from originator infliximab to a biosimilar for nonmedical/non-ocular reasons (insurance prompted the switch). One patient was started directly on infliximab-dyyb due to active joint disease despite well-controlled uveitis. None of these eight patients developed inflammation after the switch. Six patients were started directly on infliximab-dyyb due to poorly controlled uveitis. Of these, five patients achieved disease quiescence during follow-up. The mean dose of originator was 1.79 mg/kg/week, with a median dosing schedule of 4 weeks prior to therapy with infliximab-dyyb. The mean final infliximab-dyyb dosage was 1.81 mg/kg/week, with a median dosing schedule of 4 weeks. CONCLUSION Infliximab-dyyb appears to be efficacious in achieving and maintaining uveitis control.
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Affiliation(s)
- Fatma Zaguia
- Uveitis Service, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Edward L Randerson
- Uveitis Service, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ramana S Moorthy
- Uveitis Service, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Debra A Goldstein
- Uveitis Service, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Taylor PC, Askari A, Choy E, Ehrenstein MR, Else S, Nisar MK. Approaches to optimising access to NICE-approved biologic anti-TNFs for patients with rheumatoid arthritis with moderately active disease. BMC Med 2023; 21:55. [PMID: 36782189 PMCID: PMC9925364 DOI: 10.1186/s12916-023-02746-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/20/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic inflammatory disease that is associated with joint pain and stiffness. Biologics represent some of the most effective treatments for RA, but previous guidance from the National Institute for Health and Care Excellence (NICE) has limited their use to patients with severely active disease. This has meant patients with moderately active RA have been treated as if they have an acceptable disease state, despite many cases where the inflammation has a major impact on joint damage, mobility, pain and quality of life. However, recent guideline changes (NICE TA715) have approved the use of three biologics - adalimumab, etanercept and infliximab - for the treatment of moderately active RA. MAIN BODY In response to these changes, we have held discussions with medical teams from across the UK to consider the main implications for implementation of these new recommendations, as well as any differences in approach that may exist at a local level. Several key challenges were identified. These included establishing methods of educating both physicians and patients concerning the new availability of the biologic treatments, with suggestions of various organisations that could be approached to circulate informative material. Identifying which patients with moderately active RA stand to benefit was another discussion topic. Relying solely on scoring systems like Disease Activity Score in 28 Joints (DAS28) was acknowledged to have limitations, and alternative complementary approaches such as ultrasound, as well as assessing a patient's co-morbidities, could also be useful tools in determining those who could benefit from biologics. An additional challenge for the process of patient identification has been the increase in the use of telemedicine consultations in response to the coronavirus disease 2019 (COVID-19) pandemic. More use of patient-reported outcomes was raised as one possible solution, and the importance of maintaining up-to-date databases on patient disease scores and treatment history was also stressed. CONCLUSION While challenges exist in education and identifying patients who may benefit from the use of biologics, the NICE TA715 recommendations hold great potential in addressing an unmet need for the treatment of moderate RA.
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Affiliation(s)
- Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK.
| | - Ayman Askari
- Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - Ernest Choy
- Department of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Michael R Ehrenstein
- Centre for Rheumatology, UCL Division of Medicine, Rayne Building, 5 University Street, London, UK
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6
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Fautrel B, Bouhnik Y, Dieude P, Richette P, Dougados M, Freudensprung U, Brigui A, Addison J. Real-world evidence of the use of the infliximab biosimilar SB2: data from the PERFUSE study. Rheumatol Adv Pract 2023; 7:rkad031. [PMID: 37122809 PMCID: PMC10130189 DOI: 10.1093/rap/rkad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/10/2023] [Indexed: 05/02/2023] Open
Abstract
Objective PERFUSE is a non-interventional study of 1233 adult patients (rheumatology, n = 496; IBD, n = 737) receiving routine infliximab (IFX) biosimilar SB2 therapy. The aim of this report was to investigate the 12-month persistence, effectiveness and safety outcomes of routine SB2 treatment in patients with chronic inflammatory rheumatic disease. Methods Patients with a diagnosis of RA, PsA or axial spondyloarthritis (axSpA) were assigned to one of three study cohorts according to whether SB2 treatment initiated after September 2017 had been the first IFX treatment (IFX naïve) or followed transition from reference IFX (IFX ref) or another IFX biosimilar (IFX bs). Outcomes to month 12 (±2) included persistence (primary outcome), SB2 dose, disease status, immunogenicity and safety. Results At month 12, persistence on SB2 in IFX-naïve, IFX ref and IFX bs cohorts, respectively, [mean percentage (95% CI)] by indication was as follows: 59% (36.1, 76.2), 75% (57.5, 86.1) and 85% (69.6, 93.0) for RA (n = 98); 64% (34.3, 83.3), 87% (65.6, 95.7) and 83% (60.0, 93.1) for PsA (n = 62); and 56% (44.4, 66.5), 80% (70.8, 86.1) and 80% (72.5, 85.6) for axSpA (n = 336). Disease activity was comparable at baseline and month 12 within the IFX ref and bs subgroups of all cohorts by indication. No immunogenicity concerns or new safety signals were detected. Conclusion SB2 was safe and effective in IFX-naïve patients and in patients transitioned from prior IFX ref or bs. Trial registration clinicaltrials.gov, NCT03662919.
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Affiliation(s)
- Bruno Fautrel
- Correspondence to Bruno Fautrel, Rheumatology Department, Sorbonne University, AP-HP, Pitié-Salpêtrière Hospital, 47–83 boulevard de l'Hôpital, 75013 Paris, France.
| | - Yoram Bouhnik
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré—Hartmann, Neuilly-sur-Seine, France
| | - Philippe Dieude
- Department of Rheumatology, Paris-Cité University, AP-HP, Paris, France
- Hôpital Bichat-Claude Bernard, INSERM UMR1152, Paris, France
| | - Pascal Richette
- Rheumatology Department, Hôpital Lariboisière, AP-HP, Paris, France
| | - Maxime Dougados
- Department of Rheumatology, Paris-Cité University, Hôpital Cochin, AP-HP, Paris, France
- Clinical Epidemiology and Biostatistics, INSERM (U1153): PRES Sorbonne Paris-Cité, Paris, France
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Hariprasad SM, Gale RP, Weng CY, Ebbers HC, Rezk MF, Tadayoni R. An Introduction to Biosimilars for the Treatment of Retinal Diseases: A Narrative Review. Ophthalmol Ther 2022; 11:959-982. [PMID: 35278204 PMCID: PMC9114261 DOI: 10.1007/s40123-022-00488-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/16/2022] [Indexed: 12/03/2022] Open
Abstract
Biological therapies have revolutionized the treatment of disease across a number of therapeutic areas including retinal diseases. However, on occasion, such treatments may be relatively more expensive compared to small molecule therapies. This can restrict patient access and treatment length leading to suboptimal clinical outcomes. Several biosimilar candidates of ranibizumab and aflibercept are currently in development and the first biosimilar of ranibizumab received EMA approval in August and FDA approval in September 2021. Biosimilars are biological medicines that are highly similar to an already-approved biological medicine (reference product). The physicochemical and clinical similarity of a biosimilar is determined by a rigorous analytical and clinical program, including extensive pharmacokinetic and pharmacodynamic analysis with phase III equivalence studies where appropriate. These phase III studies are carried out in a patient population that is representative of all of the potential approved therapeutic indications of the originator product and the most sensitive for detecting potential differences between the biosimilar and the reference product. Biosimilars have been used successfully across a wide range of therapeutic areas for the past 15 years where they have achieved substantial cost savings that can be reinvested into healthcare systems without affecting the quality of patient care. The current review provides an introduction to biosimilars with the aim of preparing retinal specialists for discussing these products with their patients.
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Affiliation(s)
- Seenu M Hariprasad
- Department of Ophthalmology and Visual Science, University of Chicago Medicine, Chicago, IL, USA.
| | - Richard P Gale
- Department of Ophthalmology, York Teaching Hospital, University of York, York, UK
| | - Christina Y Weng
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Ramin Tadayoni
- Université de Paris, AP-HP, Lariboisière, Saint Louis and Fondation Adolphe de Rothschild Hospitals, Paris, France
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8
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Gisbert JP, Gaffney K, Young D, Ebbers HC, Girolomoni G. Current evidence on the use of the adalimumab biosimilar SB5 (Imraldi TM): a multidisciplinary perspective. Expert Opin Biol Ther 2021; 22:109-121. [PMID: 34918591 DOI: 10.1080/14712598.2022.2012146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This review provides an overview of data from trials and real-world studies available for SB5 (ImraldiTM) across three main therapeutic areas: rheumatology, gastroenterology, and dermatology. AREAS COVERED A literature search for publications on data for SB5 efficacy/effectiveness, safety, and immunogenicity was undertaken. EXPERT OPINION Evidence derived from clinical studies suggest that the biosimilar SB5 is a safe and effective alternative to reference adalimumab. Considering that patients suffering from immune-mediated inflammatory diseases such as inflammatory arthritis, inflammatory bowel disease and psoriasis often require long-term biologic treatment, biosimilar medicines (such as SB5) can reduce healthcare costs while increasing access to effective treatments.
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Affiliation(s)
- Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Karl Gaffney
- Rheumatology Department, Norfolk and Norwich Hospitals NHS Foundation Trust, Norwich, UK
| | - David Young
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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García-Beloso N, Altabás-González I, Samartín-Ucha M, Gayoso-Rey M, De Castro-Parga ML, Salgado-Barreira Á, Cibeira-Badia A, Piñeiro-Corrales MG, González-Vilas D, Pego-Reigosa JM, Martínez-López de Castro N. Switching between reference adalimumab and biosimilars in chronic immune-mediated inflammatory diseases: A systematic literature review. Br J Clin Pharmacol 2021; 88:1529-1550. [PMID: 34622969 DOI: 10.1111/bcp.15101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 08/30/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS Adalimumab is a biological therapy used to treat different chronic inflammatory diseases. At present, there is an increasing number of adalimumab biosimilars. To assume the acceptability of interchangeability between reference adalimumab and biosimilars, there should be evidence about efficacy and safety of this switching. Regulation of this practice falls under the authority of individual European Union Member States. The aim of this study is to systematically review the evidence on the efficacy, safety and immunogenicity of switching between reference adalimumab and biosimilars in different chronic immune-mediated inflammatory diseases. METHODS Studies presenting data about switching between reference adalimumab and biosimilars were identified by sensitive search strategies in Medline and EMBASE from 1 January 2004 to 30 June 2021. RESULTS A total of 471 references were obtained and 21 finally included in the analysis (total number of patients switching: 2802). Eight different adalimumab biosimilars were tested after receiving reference adalimumab. Eight articles included rheumatoid arthritis (RA), one miscellaneous rheumatic disease, six psoriasis (PSO) and six inflammatory bowel disease (IBD) patients. Overall, the efficacy results in the switching groups were comparable to those obtained in the arms of continuous biosimilar and continuous reference adalimumab. There were no significant differences in treatment emergent adverse events, anti-drug or neutralising antibodies among the three groups. CONCLUSIONS Switching between reference adalimumab and biosimilars has no impact on efficacy, safety and immunogenicity in patients with RA, PSO and IBD. This finding was consistent for the different adalimumab biosimilars analysed. These conclusions could probably be extended to other rheumatic diseases such as psoriatic arthritis and ankylosing spondylitis.
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Affiliation(s)
| | - Irene Altabás-González
- Department of Rheumatology, University Hospital Complex of Vigo, Vigo, Spain.,IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, SERGAS-UVIGO, Vigo, Spain
| | - Marisol Samartín-Ucha
- Department of Pharmacy, University Hospital Complex of Vigo, Vigo, Spain.,IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, SERGAS-UVIGO, Vigo, Spain
| | - Mónica Gayoso-Rey
- Department of Pharmacy, University Hospital Complex of Vigo, Vigo, Spain
| | | | - Ángel Salgado-Barreira
- Methodology and Statistics Unit, Galicia Sur Health Research Institute (IIS Galicia Sur, SERGAS-UVIGO, Vigo, Spain
| | - Amelia Cibeira-Badia
- Department of Scientific Library, University Hospital Complex of Vigo, Vigo, Spain
| | | | | | - Jose María Pego-Reigosa
- Department of Rheumatology, University Hospital Complex of Vigo, Vigo, Spain.,IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, SERGAS-UVIGO, Vigo, Spain
| | - Noemí Martínez-López de Castro
- Department of Pharmacy, University Hospital Complex of Vigo, Vigo, Spain.,IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, SERGAS-UVIGO, Vigo, Spain
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10
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Tolonen HM, Falck J, Kurki P, Ruokoniemi P, Hämeen-Anttila K, Shermock KM, Airaksinen M. Is There Any Research Evidence Beyond Surveys and Opinion Polls on Automatic Substitution of Biological Medicines? A Systematic Review. BioDrugs 2021; 35:547-561. [PMID: 34398421 PMCID: PMC8502744 DOI: 10.1007/s40259-021-00493-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/13/2022]
Abstract
Background Biosimilars are expected to decrease growing health care expenditures. Given that uptake of biosimilars has been modest, automatic substitution has been suggested to increase their use, but the practice is not yet allowed or implemented in many jurisdictions. Methods A systematic review was performed by searching databases Scopus, Medline (Ovid), CINAHL, and Web of Science. Peer-reviewed, original studies written in English and published during the period January 1, 2006 to April 24, 2021 reporting any interventions, pilots or any other studies including experiences or perceptions of any relevant stakeholders on automatic substitution of biologics were included without limitation by setting or geography. The quality of the included studies were evaluated by pre-determined criteria. Results Altogether, 27 studies fulfilled the inclusion criteria, of which 23 were surveys, and four semi-structured interviews reporting mainly stakeholders’ perceptions on automatic substitution. Most of the studies (56%, 15/27) were from Europe. Studies were conducted among prescribers (n = 12), pharmacists (n = 5), patients (n = 4), payers (n = 1), and mixed stakeholders (n = 5). The primary objective of the majority (81%, 22/27) of the studies was to investigate some other biosimilar topic than automatic substitution. The reported perceptions of substitution were mainly negative. Studies evaluating risks, safety or effectiveness, or reporting real-life experiences of biologic substitution were lacking except one intervention and two prospective risk management studies. The overall quality of the studies was low to moderate, and the results were not generalizable due to convenience sampling not representing the populations of interest, and low response rates. Conclusions The current research evidence on the automatic substitution of biologics is scarce and of low to moderate quality, reflecting low stakeholder knowledge and their cautious attitude towards biosimilars. The safe and efficient implementation of automatic substitution requires well-designed practices, pilot studies, and evolving legislation. Supplementary Information The online version contains supplementary material available at 10.1007/s40259-021-00493-8.
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Affiliation(s)
- Hanna M Tolonen
- HUS Pharmacy, HUS Helsinki University Hospital, Stenbäckinkatu 9, 00029, Helsinki, Finland. .,Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.
| | - Jenni Falck
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland.,University Pharmacy, Helsinki, Finland
| | | | | | | | - Kenneth M Shermock
- Center for Medication Quality and Outcomes, The Johns Hopkins Health System, Baltimore, MD, USA.,Center for Drug Safety and Effectiveness, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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11
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Chen L, Xu CJ, Wu W, Ding BJ, Liu ZJ. Anti-TNF and immunosuppressive combination therapy is preferential to inducing clinical remission in patients with active inflammatory bowel disease: A systemic review and meta-analysis. J Dig Dis 2021; 22:408-418. [PMID: 34048629 DOI: 10.1111/1751-2980.13026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/12/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of a combination therapy of biologics and immunosuppressants with biological monotherapy in inflammatory bowel disease (IBD) in a systematic review and meta-analysis. METHODS Eligible randomized controlled trials (RCTs) on the comparison of the efficacy and safety of biologics and immunomodulators with biological monotherapy were identified from the EMBASE, PubMed and the Cochrane Library databases published up to 1 May 2020. Raw data were extracted, pooled relative risk (RR) and 95% confidence interval (CI) was calculated, the fixed-effect and inverse variance models were used. Funnel plots were performed to analyze publication bias. RESULTS Twelve RCTs were eligible for analysis. Overall, there was statistically a benefit for combination treatment over biologic monotherapy (IFX/ADA) in inducing clinical remission and preventing relapse in patients with IBD (RR 0.89, 95% CI 0.80-0.98). Moreover, the combination therapy was superior to biological monotherapy for active CD (RR 0.83, 95% CI 0.73-0.94). Also, there were significant benefits for combination therapy in the subgroup treated with infliximab (IFX) (RR 0.83, 95% CI 0.70-0.97). CONCLUSIONS Combination therapy has slight benefits in inducing clinical remission in active CD compared with biological monotherapy. Patients with IBD who receive therapy with IFX and immunomodulator also have a mild advantage in comparison with those treated with IFX monotherapy.
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Affiliation(s)
- Liang Chen
- Department of Gastroenterology, The First People's Hospital of Shangqiu City, Xinxiang Medical University, Shangqiu, Henan Province, China.,Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Chun Jin Xu
- Department of Gastroenterology, The First People's Hospital of Shangqiu City, Xinxiang Medical University, Shangqiu, Henan Province, China
| | - Wei Wu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Bai Jing Ding
- Department of Gastroenterology, Wuhu First People's Hospital, Wuhu, Anhui Province, China
| | - Zhan Ju Liu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
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García-Goñi M, Río-Álvarez I, Carcedo D, Villacampa A. Budget Impact Analysis of Biosimilar Products in Spain in the Period 2009-2019. Pharmaceuticals (Basel) 2021; 14:ph14040348. [PMID: 33918795 PMCID: PMC8069914 DOI: 10.3390/ph14040348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022] Open
Abstract
Since the first biosimilar medicine, Omnitrope® (active substance somatropin) was approved in 2006, 53 biosimilars have been authorized in Spain. We estimate the budget impact of biosimilars in Spain from the perspective of the National Health System (NHS) over the period between 2009 and 2019. Drug acquisition costs considering commercial discounts at public procurement procedures (hospital tenders) and uptake data for both originator and biosimilar as actual units consumed by the NHS were the two variables considered. Two scenarios were compared: a scenario where no biosimilars are available and the biosimilar scenario where biosimilars are effectively marketed. All molecules exposed to biosimilar competition during this period were included in the analysis. The robustness of the model was tested by conducting multiple sensitivity analyses. From the payer perspective, it is estimated that the savings produced by the adoption of biosimilars would reach EUR 2306 million over 11 years corresponding to the cumulative savings from all biosimilars. Three molecules (infliximab, somatropin and epoetin) account for 60% of the savings. This study provides the first estimation of the financial impact of biosimilars in Spain, considering both the effect of discounts that manufacturers give to hospitals and the growing market share of biosimilars. We estimate that in our last year of data, 2019, the savings derived from the use of biosimilars relative total pharmaceutical spending in Spain is 3.92%. Although more research is needed, our evidence supports the case that biosimilars represent a great opportunity to the sustainability of the NHS through rationalizing pharmaceutical spending and that the full potential of biosimilar-savings has not been achieved yet, as there is a high variability in biosimilar uptake across autonomous regions.
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Affiliation(s)
- Manuel García-Goñi
- Department of Applied & Structural Economics and History, Faculty of Economics and Business, Complutense University of Madrid, Campus de Somosaguas, Pozuelo de Alarcón, 28223 Madrid, Spain
- Correspondence: ; Tel.: +34-91-394-30-00
| | | | - David Carcedo
- Hygeia Consulting S. L., 28046 Madrid, Spain; (D.C.); (A.V.)
| | - Alba Villacampa
- Hygeia Consulting S. L., 28046 Madrid, Spain; (D.C.); (A.V.)
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13
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Moorkens E, Vulto AG, Kent J, McClure L, Boldero R, Vanhove T, Simoens S, Huys I. A Look at the History of Biosimilar Adoption: Characteristics of Early and Late Adopters of Infliximab and Etanercept Biosimilars in Subregions of England, Scotland and Wales - A Mixed Methods Study. BioDrugs 2021; 35:75-87. [PMID: 33306186 PMCID: PMC7803694 DOI: 10.1007/s40259-020-00456-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Regions within England, Scotland and Wales show variation in rate of adoption of biosimilar infliximab and etanercept. Objectives This study aims to examine how local decisions and practices in regions within England, Scotland and Wales might explain initial variation in market dynamics of biosimilar and originator infliximab and etanercept. Methods Market data provided by the National Health Service (NHS) on biosimilar and originator infliximab and etanercept uptake were analysed for the 10 historical regions of England, 14 health boards in Scotland and 7 health boards in Wales (2015–2018). Findings were discussed in ten semi-structured interviews: on a national level with an industry representative (1), on a regional level with NHS employees in England (6), Scotland (1) and Wales (1), and on a local level with a representative of a clinical commissioning group in England (1). Results Tenders for infliximab and etanercept in England, Scotland and Wales have consistently resulted in a biosimilar as the best value biological. Early and late biosimilar adopters are seen, with overall convergence towards high biosimilar market shares over time. Qualitative results suggest that biosimilar adoption was positively influenced by (a) a price difference between biosimilar and originator product making it worthwhile to switch patients; (b) a good relationship between commissioner and provider in England resulting in gain share agreements; (c) leadership on biosimilars in regional NHS offices in England or Scottish and Welsh health boards; (d) key opinion leaders or leading hospitals that start using biosimilars early and gain experience. Conclusions This study has shown that the savings potential drives biosimilar use. Regions with a proactive attitude, good stakeholder relationships, and clinician engagement were identified as early adopters.
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Affiliation(s)
- Evelien Moorkens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium. .,Hospital Pharmacy, The Erasmus University Medical Center, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - James Kent
- Specialist Pharmacy Service, NHS England, London, UK
| | | | - Richard Boldero
- All Wales Therapeutics and Toxicology Centre, NHS Wales, Cardiff, UK
| | | | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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14
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Switching to an Infliximab Biosimilar Was Safe and Effective in Dutch Sarcoidosis Patients. Cells 2021; 10:cells10020441. [PMID: 33669641 PMCID: PMC7922542 DOI: 10.3390/cells10020441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/20/2022] Open
Abstract
The effect of switching from originator infliximab to biosimilar infliximab in patients with sarcoidosis is unknown. The objective of this study is to investigate the effect of switching from Remicade® or Inflectra® to Flixabi® in patients with severe refractory sarcoidosis. This single center retrospective cohort study was performed at St Antonius Hospital Nieuwegein, The Netherlands. All patients diagnosed with severe refractory sarcoidosis receiving Remicade® or Inflectra® switched to Flixabi®. The primary outcome was infliximab discontinuation within 6 months of switching. Secondary endpoints included adverse events and loss of clinical, functional, or inflammatory response. Out of 86 patients who switched to Flixabi®, 79 patients had complete data. None of the 79 patients discontinued infliximab during the first 6 months after switching. Five patients reported an adverse event related to Flixabi® treatment. We found no change from baseline in FVC, FEV1, DLCOc, 6MWT, and infliximab trough levels 26 weeks after switching. An improvement in physical functioning of 7.3 ± 13.4 points (p = 0.002) with RAND/SF36 and in biomarker sIL-2R (−475.58 ± 1452.39; p = 0.005) was observed. Switching from originator infliximab Remicade® or biosimilar infliximab Inflectra® to biosimilar infliximab Flixabi® did not result in treatment discontinuation or loss of clinical/functional/inflammatory remission.
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15
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Esse S, Mason KJ, Green AC, Warren RB. Melanoma Risk in Patients Treated With Biologic Therapy for Common Inflammatory Diseases: A Systematic Review and Meta-analysis. JAMA Dermatol 2021; 156:787-794. [PMID: 32432649 DOI: 10.1001/jamadermatol.2020.1300] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Biologic therapies are widely prescribed immunomodulatory agents. There are concerns that compared with treatment with conventional systemic therapy, long-term biologic treatment for common immune-mediated inflammatory diseases, namely inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and psoriasis, may be associated with increased risk of melanoma. Objective To examine whether biologic treatment of IBD, RA, or psoriasis is associated with an increased risk of melanoma compared with conventional systemic therapy. Data Sources Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for articles published from January 1, 1995, to February 7, 2019, for eligible studies. Study Selection Randomized clinical trials, cohort studies, and nested case-control studies quantifying the risk of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with patients treated with conventional systemic therapy were included. Data Extraction and Synthesis Two reviewers independently extracted key study characteristics and outcomes. Study-specific risk estimates were pooled, and random- and fixed-effects model meta-analyses were conducted. Heterogeneity was assessed using the I2 statistic. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. Main Outcomes and Measures The pooled relative risk (pRR) of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with biologic-naive patients treated with conventional systemic therapy. Results Seven cohort studies comprising 34 029 biologic-treated patients and 135 370 biologic-naive patients treated with conventional systemic therapy were eligible for inclusion. Biologic treatment was positively associated with melanoma in patients with IBD (pRR, 1.20; 95% CI, 0.60-2.40), RA (pRR, 1.20; 95% CI, 0.83-1.74), or psoriasis (hazard ratio, 1.57; 95% CI, 0.61-4.09) compared with those who received conventional systemic therapy, but the differences were not statistically significant. Adjustment for other risk factors was absent from most studies. Conclusions and Relevance The findings suggest that clinically important increases in melanoma risk in patients treated with biologic therapy for common inflammatory diseases cannot be ruled out based on current evidence. However, further studies with large patient numbers that adjust for key risk factors are needed to resolve the issue of long-term safety of biologic therapy.
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Affiliation(s)
- Shamarke Esse
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, United Kingdom.,Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Kayleigh J Mason
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Adele C Green
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom.,QIMR Berghofer Medical Research Institute, Brisbane, New South Wales, Australia.,Cancer Research UK Manchester Institute, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Richard B Warren
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
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16
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Choy E, Groves L, Sugrue D, Hurst M, Houghton J, Venkatachalam S, Patel YI, Maxwell JR, Pollock KG, Henning S. Outcomes in rheumatoid arthritis patients treated with abatacept: a UK multi-centre observational study. BMC Rheumatol 2021; 5:3. [PMID: 33536080 PMCID: PMC7857859 DOI: 10.1186/s41927-020-00173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that causes chronic synovitis, resulting in progressive joint destruction and functional disability and affects approximately 400,000 people in the UK. This real-world study aimed to describe the characteristics, treatment patterns and clinical outcomes of patients who received abatacept in UK clinical practice. METHODS This was a multi-centre, retrospective, observational study of patients with RA treated with abatacept at four UK centres between 01 January 2013 and 31 December 2017. Data were collected from medical records of each patient from the index date (date of first bDMARD initiation) until the most recent visit, death or end of study (31 December 2017). RESULTS In total, 213 patients were included in the study. Patients received up to eight lines of therapy (LOTs). Treatment with abatacept, or any other bDMARD, was associated with reductions in DAS28-ESR and DAS28-CRP scores at 6 and 12 months. The distribution of EULAR responses (good/moderate/no response) tended to be more favourable for patients when receiving abatacept than when receiving other bDMARDs (22.8%/41.3%/35.9% versus 16.6%/41.4%/42.1% at 6 months, and 27.9%/36.1%/36.1% versus 21.2%/34.5%/44.2% at 12 months). Patients receiving abatacept at LOT1 (n = 68) spent significantly longer on treatment compared with patients receiving other bDMARDs (53.4 vs. 17.4 months; p< 0.01); a similar trend was observed for LOT2. Among patients who discontinued after 6 months, a greater proportion experienced infection requiring antibiotics when receiving other bDMARDs compared to those receiving abatacept. CONCLUSIONS RA patients who received bDMARDs, including abatacept, experienced reduced disease activity. When receiving abatacept as first or second line of therapy, patients persisted with treatment significantly longer than those receiving other bDMARDs.
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Affiliation(s)
- Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University School of Medicine, Wales, UK
- Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Lara Groves
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Daniel Sugrue
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Michael Hurst
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - John Houghton
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Srinivasan Venkatachalam
- Cannock and Wolverhampton Rheumatology Centre, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Yusuf I Patel
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | - Kevin G Pollock
- Bristol Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, Middlesex, UK
| | - Sadie Henning
- Bristol Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, Middlesex, UK.
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17
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Müskens WD, Rongen-van Dartel SAA, van Riel PLCM, Adang EMM. Does Etanercept Biosimilar Prescription in a Rheumatology Center Bend the Medication Cost Curve? J Rheumatol 2020; 48:1803-1809. [PMID: 33132223 DOI: 10.3899/jrheum.200565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The market entry of biosimilars is expected to bring budgetary relief. Our objective was to determine how the introduction of biosimilars influences medication costs in patients with rheumatoid arthritis (RA) and which patients gain access to biologics due to the availability of biosimilars. METHODS Using hospital data of patients with RA between 2014 and 2018, an interrupted time series was performed. The interruption in the time series was placed at June 2016 (i.e., the introduction of the etanercept biosimilar). The changes in trends for rheumatic medication costs before and after the interruption were measured. Secondary analyses focused on explaining these trends. RESULTS In the first quarter after the interruption, there was a decrease in total costs for biologic users of -€63,020 (95% CI -€96,487 to -€29,553, P = 0.001). The postinterruption trend did not differ from the preinterruption trend (95% CI -€6695 to €6715, P = 0.998) and after 3 quarters, the medication costs were back at the interruption level. After the interruption, the average cost per biologic user decreased by -€370 (95% CI -€602 to -€138, P = 0.005), followed by a quarterly decrease (relative to the preinterruption trend; 95% CI -€86 to -€14, P = 0.010), bending the average cost curve. The percentage of patients being treated with biologics increased in postinterruption by 0.50 percentage points quarterly (95% CI 0.38-0.62, P < 0.001). Also, the average age at the start of the first biologic increased after the interruption (P = 0.057). CONCLUSION The average cost per patient treated with biologics decreased after the introduction of biosimilars with a persistent trend. However, the budgetary relief due to market entry of biosimilars vanished quickly due to an increase in patients treated with biologics.
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Affiliation(s)
- Wieland D Müskens
- W.D. Müskens, MD, MSc, Department of IQ Healthcare, Radboudumc, Nijmegen;
| | - Sanne A A Rongen-van Dartel
- S.A. Rongen-van Dartel, PhD, P.L. van Riel, MD, PhD, Department of IQ Healthcare, Radboudumc, Nijmegen, and Department of Rheumatology, Bernhoven, Uden
| | - Piet L C M van Riel
- S.A. Rongen-van Dartel, PhD, P.L. van Riel, MD, PhD, Department of IQ Healthcare, Radboudumc, Nijmegen, and Department of Rheumatology, Bernhoven, Uden
| | - Eddy M M Adang
- E.M. Adang, PhD, Department of Health Evidence, Radboudumc, Nijmegen, the Netherlands
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18
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Rezk MF, Pieper B. Unlocking the Value of Anti-TNF Biosimilars: Reducing Disease Burden and Improving Outcomes in Chronic Immune-Mediated Inflammatory Diseases: A Narrative Review. Adv Ther 2020; 37:3732-3745. [PMID: 32740789 PMCID: PMC7444394 DOI: 10.1007/s12325-020-01437-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 02/07/2023]
Abstract
Immune-mediated inflammatory diseases (IMIDs) are chronic conditions that create a significant disease burden on millions of patients while adding a major financial burden to societies and healthcare systems. The introduction of biologic medicines has contributed majorly to improving the clinical outcomes of IMIDs and as such these modalities have gained first- or second-line positions in a wide range of treatment guidelines from different international clinical societies. However, the high cost of these biologics traditionally limited their accessibility and delayed their initiation, leaving millions of patients with unmet medical needs for a more affordable and sustainable solution. The introduction of cost-efficient biosimilar anti-TNFs within Europe since 2013 has allowed more patients with IMIDs to access biologic therapies earlier and for longer, potentially altering the course of the disease into a milder phenotype and reducing the long-term disease burden. This review provides the latest evidence for the impact of biosimilars on patient outcomes and demonstrates their clinical value beyond a reduction in price.
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Affiliation(s)
- Mourad F Rezk
- Biogen International GmbH, Neuhofstrasse 30, 6340, Baar, Switzerland.
| | - Burkhard Pieper
- Biogen International GmbH, Neuhofstrasse 30, 6340, Baar, Switzerland
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Ascef BDO, Lopes ACDF, de Soárez PC. Health technology assessment of biosimilars worldwide: a scoping review. Health Res Policy Syst 2020; 18:95. [PMID: 32843051 PMCID: PMC7448328 DOI: 10.1186/s12961-020-00611-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Health technology assessment (HTA) should provide an assessment of a technology's effects on health and of the related social, economic, organisational and ethical issues. HTA reports on biosimilars can specifically assess their immunogenicity, their extrapolation to one or more conditions, and the risks of interchangeability and substitution. We aimed to complete a scoping review within the context of HTA organisations to synthesise HTA reports on biosimilars and to map the extension, scope and methodological practices. MAIN BODY A scoping review methodology was applied. The sources for biosimilars HTA reports were database searches and grey literature from HTA organisation websites up to June 2019. HTA reports of biosimilars were classified as full HTA, mini-HTA or rapid reviews. Data were extracted and recorded on a calibrated predefined data form. We identified 70 HTA reports of biosimilars of 16 biologic products (65.71% in 2015-2018) produced by 13 HTA organisations from 10 countries; 2 full HTAs, 4 mini-HTAs and 64 rapid reviews met the inclusion criteria. Almost all the rapid reviews gave no information regarding any evidence synthesis method and approximately half of the rapid reviews did not appraise the risk of bias of primary studies or the overall quality of evidence. All full-HTAs and mini-HTAs addressed organisational, ethical, social and legal considerations, while these factors were assessed in less than half of the rapid reviews. The immunogenicity and extrapolation of one or more conditions were often considered. The majority of full-HTAs and mini-HTAs contained an assessment of switching and a discussion of an educational approach about biosimilars. No HTA report rejected the adoption/reimbursement of the biosimilar assessed. CONCLUSION HTA of biosimilars are emerging in the context of HTA organisations and those that exist often duplicate reports of the same biosimilar. Most HTA reports of biosimilars do not conduct a systematic literature review or consider economic issues. No report has rejected the adoption/reimbursement of biosimilars. There is a need to standardise the minimum criteria for the development of HTA on biosimilars to ensure a better understanding and better decision-making.
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Affiliation(s)
- Bruna de Oliveira Ascef
- Preventive Medicine Department, Faculty of Medicine, The University of São Paulo, Av. Dr. Arnaldo, 455, sala 2228, São Paulo, SP CEP: 01246-903 Brazil
| | - Ana Carolina de Freitas Lopes
- Preventive Medicine Department, Faculty of Medicine, The University of São Paulo, Av. Dr. Arnaldo, 455, sala 2228, São Paulo, SP CEP: 01246-903 Brazil
| | - Patrícia Coelho de Soárez
- Preventive Medicine Department, Faculty of Medicine, The University of São Paulo, Av. Dr. Arnaldo, 455, sala 2228, São Paulo, SP CEP: 01246-903 Brazil
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Esse S, Mason KJ, Green AC, Warren RB. Melanoma Risk in Patients Treated With Biologic Therapy for Common Inflammatory Diseases: A Systematic Review and Meta-analysis. JAMA Dermatol 2020; 156:787-794. [PMID: 32432649 PMCID: PMC7240639 DOI: 10.1001/jamadermatol.2020.1300.doi: 10.1001/jamadermatol.2020.1300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/21/2020] [Indexed: 10/24/2023]
Abstract
IMPORTANCE Biologic therapies are widely prescribed immunomodulatory agents. There are concerns that compared with treatment with conventional systemic therapy, long-term biologic treatment for common immune-mediated inflammatory diseases, namely inflammatory bowel disease (IBD), rheumatoid arthritis (RA), and psoriasis, may be associated with increased risk of melanoma. OBJECTIVE To examine whether biologic treatment of IBD, RA, or psoriasis is associated with an increased risk of melanoma compared with conventional systemic therapy. DATA SOURCES Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for articles published from January 1, 1995, to February 7, 2019, for eligible studies. STUDY SELECTION Randomized clinical trials, cohort studies, and nested case-control studies quantifying the risk of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with patients treated with conventional systemic therapy were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted key study characteristics and outcomes. Study-specific risk estimates were pooled, and random- and fixed-effects model meta-analyses were conducted. Heterogeneity was assessed using the I2 statistic. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines were followed. MAIN OUTCOMES AND MEASURES The pooled relative risk (pRR) of melanoma in biologic-treated patients with IBD, RA, and psoriasis compared with biologic-naive patients treated with conventional systemic therapy. RESULTS Seven cohort studies comprising 34 029 biologic-treated patients and 135 370 biologic-naive patients treated with conventional systemic therapy were eligible for inclusion. Biologic treatment was positively associated with melanoma in patients with IBD (pRR, 1.20; 95% CI, 0.60-2.40), RA (pRR, 1.20; 95% CI, 0.83-1.74), or psoriasis (hazard ratio, 1.57; 95% CI, 0.61-4.09) compared with those who received conventional systemic therapy, but the differences were not statistically significant. Adjustment for other risk factors was absent from most studies. CONCLUSIONS AND RELEVANCE The findings suggest that clinically important increases in melanoma risk in patients treated with biologic therapy for common inflammatory diseases cannot be ruled out based on current evidence. However, further studies with large patient numbers that adjust for key risk factors are needed to resolve the issue of long-term safety of biologic therapy.
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Affiliation(s)
- Shamarke Esse
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, United Kingdom
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Kayleigh J. Mason
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Adele C. Green
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
- QIMR Berghofer Medical Research Institute, Brisbane, New South Wales, Australia
- Cancer Research UK Manchester Institute, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Richard B. Warren
- Dermatology Centre, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
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21
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Vasudevan A, Ip F, Liew D, van Langenberg DR. The Cost-effectiveness of Initial Immunomodulators or Infliximab Using Modern Optimization Strategies for Crohn's Disease in the Biosimilar Era. Inflamm Bowel Dis 2020; 26:369-379. [PMID: 31532479 DOI: 10.1093/ibd/izz159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment cost, efficacy, and safety are integral considerations when optimizing management of Crohn's disease (CD). This study assessed the cost-effectiveness of initial immunomodulator and anti-tumor necrosis factor (anti-TNF) agents for the treatment of CD from a US third-party perspective, incorporating current treatment algorithms, optimization strategies, and reduced costs availed by biosimilars. METHOD A 1-year Markov model was developed to simulate the cost and quality-adjusted life-years (QALYs) of initial azathioprine, infliximab, and combination therapy for moderate to severe CD. Treatment was changed based on tolerability and clinical disease activity at 3-monthly intervals. Efficacy data were based on published literature. RESULTS Initial azathioprine had the lowest cost and utility ($35,337 and 0.63 QALYs), whereas combination therapy was the costliest yet conferred the highest health benefits ($57,638 and 0.67 QALYs). The incremental cost-effectiveness of infliximab and combination therapy compared with azathioprine were both in excess of $500,000 per QALY gained. Initial azathioprine remained the most cost-effective treatment on sensitivity analysis compared with infliximab and combination therapy, with 90% reductions in anti-TNF therapy costs and a 5-year time horizon, although combination therapy had an acceptable cost-effectiveness when costs were reduced in the extended model. Initial infliximab, ustekinumab, and vedolizumab were dominated by combination therapy. CONCLUSIONS In the biosimilar era, initial azathioprine with escalation to infliximab appeared more cost-effective in the short term compared with infliximab or combination therapy, although initial combination therapy yields acceptable ICERs in the long term with continued reductions in anti-TNF therapy costs and will likely be the preferred treatment strategy in the future.
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Affiliation(s)
- Abhinav Vasudevan
- Department of Gastroenterology and Hepatology, Eastern Health, Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Francis Ip
- School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniel R van Langenberg
- Department of Gastroenterology and Hepatology, Eastern Health, Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
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22
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Song YW, Park YB, Kim J. LBEC0101, an etanercept biosimilar for the treatment of rheumatoid arthritis. Expert Opin Biol Ther 2019; 21:1-8. [PMID: 31801395 DOI: 10.1080/14712598.2020.1701650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Treatment of rheumatoid arthritis (RA) has been revolutionized by the introduction of biologic disease-modifying antirheumatic drugs, such as tumor necrosis factor (TNF) inhibitors. With patent expiry approaching for many expensive biologic molecules, such as etanercept, more affordable biosimilar drugs are being developed. LBEC0101 is an etanercept biosimilar approved in Japan and South Korea for all etanercept indications including RA. Areas covered: We discuss the pharmacological characteristics, pharmacokinetics, efficacy, and safety of LBEC0101 compared with the etanercept reference product (ETN-RP). Preclinical studies showed that the binding affinity to TNFα and biological activity of LBEC0101 were similar to those of the ETN-RP. The pharmacokinetic profile of LBEC0101 was also similar to that of the ETN-RP. A Phase III, randomized, double-blind, 54-week study showed that the efficacy of LBEC0101 was equivalent to that of the ETN-RP in RA patients. An extension study showed that efficacy was sustained long-term in patients receiving LBEC0101 and in those switching from the ETN-RP to LBEC0101. The safety profile of LBEC0101 was also confirmed to be comparable with the ETN-RP. Expert opinion: LBEC0101 has shown equivalent pharmacokinetics and efficacy and comparable safety to the ETN-RP, and the lower cost of LBEC0101 provides a good cost-benefit ratio.
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Affiliation(s)
- Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital , Seoul, South Korea.,Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Seoul National University , Seoul, South Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine , Seoul, South Korea
| | - Jinseok Kim
- Division of Rheumatology, Jeju National University Hospital , Jeju, South Korea
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Fabiani C, Vitale A, Emmi G, Sgheri A, Lopalco G, Sota J, Guerriero S, Iannone F, Frediani B, Vannozzi L, Bianco MT, Giovannini V, Tosi GM, Cantarini L. The Role of Biosimilars in Uveitis: Long-Term Real-World Outcomes of the Switch From Original to Biosimilar TNF-Alpha Inhibitors. Front Pharmacol 2019; 10:1468. [PMID: 31920658 PMCID: PMC6913067 DOI: 10.3389/fphar.2019.01468] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/13/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Recent expiry of patents for tumor necrosis factor (TNF)-α inhibitors has led to the employment of biosimilars in clinical practice. The aim of the study was to identify any change in the control of ocular inflammatory manifestations among patients with non-infectious uveitis switching from an originator to a corresponding anti-TNF-α biosimilar. Methods: Thirty-seven consecutive patients (62 eyes involved) with non-infectious uveitis undergoing the switch from anti-TNF-α originators to biosimilars were retrospectively enrolled; the frequency of ocular flares before and after the switch as well as best corrected visual acuity (BCVA), central macular thickness (CMT), daily systemic corticosteroid intake, and frequency of uveitic macular edema (UME) at the switch and at the following assessments were statistically analysed. Results: The number of ocular flares during the 12 months preceding the switch was 16, corresponding to 3.6 flares/100 patients/12 months; the number of flares after the switch was 14, corresponding to 2.0 flares/100 patients/12 months. No statistically significant differences were identified in the frequency of flares (p = 0.84) and in the number of patients experiencing ocular flares (p = 0.39) between the twelve months preceding the switch and the period thereafter. No statistically significant changes were observed in the BCVA (p = 0.27), CMT (p = 0.50), frequency of UME (p = 0.57) and daily corticosteroid intake (p = 0.42) between the time of the switch and the last follow-up visit. Conclusions: The switch to biosimilars represents a feasible treatment choice associated with the maintenance of clinical efficacy in patients with non-infectious uveitis previously treated with the corresponding originator anti-TNF-α biologic agents.
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Affiliation(s)
- Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Antonio Vitale
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Arianna Sgheri
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Jurgen Sota
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Silvana Guerriero
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Bruno Frediani
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Lorenzo Vannozzi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Maria Teresa Bianco
- Pharmacy Unit, Siena University Hospital "Santa Maria alle Scotte", Siena, Italy
| | - Valtere Giovannini
- Azienda Ospedaliera Universitaria Senese, Le Scotte Hospital, Siena, Italy
| | - Gian Marco Tosi
- Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luca Cantarini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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24
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da Silva MRR, Dos Santos JBR, Almeida AM, Guerra Júnior AA, Alvares Teodoro J, Acurcio FDA. Biological therapy in the treatment of psoriatic arthritis: economic and epidemiological considerations. Expert Rev Clin Immunol 2019; 15:879-887. [PMID: 31192746 DOI: 10.1080/1744666x.2019.1631798] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Biological therapies have a significant economic and clinical burden but, in general, lose their effectiveness over time. This study evaluated the medication persistence and costs associated to use of anti-TNF agents for psoriatic arthritis (PsA) treatment. Methods: A historical cohort composed of individuals in Brazil with PsA diagnosis was developed during the period between 2010 and 2015. The difference among the anti-TNF agents was verified by the log-rank test. The predictors of medication non-persistence were identified by Cox regression. The costs were compared by variance analysis with Bonferroni correction. Results: 11,008 patients were analyzed. Adalimumab (51%) was the most used anti-TNF agent. Individuals using adalimumab presented higher medication persistence as compared to etanercept and infliximab. The costs with anti-TNF agents corresponded to 90% of the total costs and were similar among anti-TNF agents. The non-persistence predictors were female sex, younger patients, to live in the Northeastern and Northern regions of Brazil, to use infliximab and etanercept, and have more comorbidities. Conclusion: The direct costs with anti-TNF agents were the main component of total costs. Outpatient and inpatient costs increase when medication persistence decreases. A considerable price reduction of anti-TNF agents has been observed over the years.
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Affiliation(s)
- Michael Ruberson Ribeiro da Silva
- a Postgraduate Program in Medicines & Pharmaceutical Services, College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil
| | - Jéssica Barreto Ribeiro Dos Santos
- a Postgraduate Program in Medicines & Pharmaceutical Services, College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil
| | - Alessandra Maciel Almeida
- b College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil.,c Institute of Research and Postgraduate in Medical Sciences, Faculty of Medical Sciences of Minas Gerais , Minas Gerais , Brasil
| | | | | | - Francisco de Assis Acurcio
- b College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil.,d Department of Social and Preventive Medicine, School of Medicine, Federal University of Minas Gerais , Minas Gerais , Brazil
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25
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Ylisaukko-Oja T, Torvinen S, Ventola H, Schmidt S, Herrala S, Kononoff J, Voutilainen M. Healthcare resource utilization and treatment costs of Finnish chronic inflammatory bowel disease patients treated with infliximab . Scand J Gastroenterol 2019; 54:726-732. [PMID: 31203693 DOI: 10.1080/00365521.2019.1627579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: Inflammatory bowel disease (IBD) is associated with a high economic burden to society due to its early onset and chronic character. Here, we set out to characterize healthcare resource utilization and associated costs in Crohn's disease (CD) and ulcerative colitis (UC) patients with infliximab treatment, the most widely used first-line biologic agent in Finland, in a real-world clinical setting. Methods: This was a retrospective, non-interventional single-center study. Infliximab was administered in routine care, and data were collected retrospectively from electronic health records. All adult anti-TNF naïve CD or UC patients whose infliximab treatment was initiated at the Hospital District of Southwest Finland between the years of 2014 and 2016 were included in the study. Each patient was followed-up for 12 months after the initiation of infliximab treatment. Results: A total of 155 patients were included (45 CD, 110 UC). Altogether, 60.0% (n = 27) of all CD patients and 43.6% (n = 48) of all UC patients persisted on infliximab therapy 12 months after treatment initiation. The total cost was similar for both CD and UC cohorts (CD, €10,243; UC, €10,770), infliximab treatment being the highest individual cost (60.3% of the total cost in CD; 53.4% in UC). The mean number of infliximab infusions during the 12-month follow-up was 7.0 for CD and 6.5 for UC patients. Conclusions: IBD causes a significant burden to the Finnish healthcare system. This study provides a detailed characterization of the cost landscape of IBD and contributes to optimizing treatment strategies and healthcare resource use in the biosimilar era.
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Affiliation(s)
- Tero Ylisaukko-Oja
- MedEngine Oy , Helsinki , Finland.,Center for Life Course Health Research, University of Oulu , Oulu , Finland
| | | | | | | | | | | | - Markku Voutilainen
- Division of Medicine, Turku University Hospital , Turku , Finland.,Department of Medicine, University of Turku , Turku , Finland
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27
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Edwards CJ, Hercogová J, Albrand H, Amiot A. Switching to biosimilars: current perspectives in immune-mediated inflammatory diseases. Expert Opin Biol Ther 2019; 19:1001-1014. [PMID: 31056970 DOI: 10.1080/14712598.2019.1610381] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: The expiry of patents for biologics has led to the introduction of biosimilars for the treatment of immune-mediated inflammatory diseases (IMIDs). These treatment alternatives may allow earlier and wider access to appropriate therapy for patients without increasing the economic burden on health-care systems. Prescription of biosimilars to treatment-naïve patients is well accepted; however, additional considerations must be taken into account when switching clinically stable patients from reference products to biosimilars. Area covered: We discuss the current considerations related to switching from reference products to biosimilars from a physician and patient perspective. We review the clinical data and real-life experience on switching patients with IMIDs, present the position of the relevant medical societies, and discuss the importance of patient-physician communication and need for shared decision-making. Expert opinion: The introduction of biosimilars provides an opportunity to expand access to treatment for patients with IMIDs across Europe and support the financial sustainability of health-care systems. We anticipate that as the real-world evidence base grows, confirming the results of clinical trials, there will be a corresponding increase in physician and patient acceptance, not only to initiating treatment with a biosimilar, but also to switching medication from a reference product to a biosimilar.
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Affiliation(s)
- Christopher J Edwards
- NIHR Clinical Research Facility, University Hospital Southampton NHS Foundation Trust , Southampton , UK
| | - Jana Hercogová
- Dermatology Department, 2nd Medical faculty, Charles University and Na Bulovce Hospital , Prague , Czech Republic
| | | | - Aurelian Amiot
- Department of Gastroenterology and EC2M3-EA7375 Unit, Assistance Publique-Hôpitaux de Paris, Paris Est Creteil University, Henri Mondor Hospital , Creteil , France
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28
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Baumgart DC, Misery L, Naeyaert S, Taylor PC. Biological Therapies in Immune-Mediated Inflammatory Diseases: Can Biosimilars Reduce Access Inequities? Front Pharmacol 2019; 10:279. [PMID: 30983996 PMCID: PMC6447826 DOI: 10.3389/fphar.2019.00279] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/05/2019] [Indexed: 12/30/2022] Open
Abstract
Biological therapies are an effective treatment for a range of immune-mediated inflammatory diseases (IMIDs), including rheumatoid arthritis, psoriasis, and inflammatory bowel diseases. However, due to their high costs, considerable differences in their utilization exist across the world, even among the various European countries, with many countries restricting access despite professional society guideline recommendations. Adoption of biologics by healthcare providers has been particularly poor in many Central and Eastern European countries. Differences in utilization have also been observed across medical specialties, healthcare providers, and at a regional and national level. The objective of this paper is to provide an overview of the different market access policies for biologics in Europe and to investigate reasons for such differences. One of the potential solutions for providing broader access to IMID patients, where cost is the major barrier, is to encourage the use of biosimilars in place of their reference products. Biosimilars are generally less expensive alternatives to already licensed biological therapies and are approved on the basis that they are similar to the reference product in terms of quality, safety, and efficacy. Budget impact models predict considerable cost savings following the introduction of biosimilars in the next few years. These savings could be used to increase access to biologics and other innovative therapies.
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Affiliation(s)
- Daniel C. Baumgart
- Inflammatory Bowel Disease Unit – Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
- Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt-University of Berlin, Berlin, Germany
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | | | - Peter C. Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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29
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Mehr SR, Brook RA. Biosimilars in the USA: Will New Efforts to Spur Approvals and Access Spur Uptake and Cost Savings? Pharmaceut Med 2019; 33:1-8. [DOI: 10.1007/s40290-018-00262-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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30
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Mennini FS, Marcellusi A, Bini C, Rotundo MA, Giunta A, Gasbarrini A, Valesini G, Canonico PL, Novellino E, Orlando V, Mecozzi A, Gamucci T, Pagano L, Di Brino E, Ruggeri M, Cicchetti A. The economic impact of biosimilars in Italy: a scenario analysis. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2019. [DOI: 10.1177/2284240319858022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: the first generation of biotechnology drugs is reaching, or has already reached, the patent expiry and a large number of biosimilars is entering the Italian pharmaceutical market. The objective of the analysis was to evaluate the economic impacts of biosimilars on the national health expenditure in Italy between 2014 and 2020. Methods: Based on the information deriving from consumption per standard unit and equivalent patients, it was estimated monthly expenditure for some of the biological drugs currently available in Italy that have had or will have a patent expiry within the analysis period (infliximab, etanercept, adalimumab, insulin glargine, trastuzumab, rituximab, bevacizumab and insulin aspart). Pharmaceutical expenditure was calculated on hospital sales prices net of transparent discounts required by law and visible from the AIFA database. Three alternative scenarios have been developed based on the perceptions of a board of clinical experts, pharmacologists and pharmacoeconomists involved in the study. The experts involved analyzed the estimates of treated patients between 2014 and 2017 and reports their hypothetical biosimilar penetration during the period 2018-2020. The results were represented as the difference between the estimated expenditure in the absence of biosimilars and the estimated expenditure in the presence of biosimilars with the real or hypothetical biosimilar penetration. Results: considering the standard units dispensed for each year, the economic model estimate an annual expenditure in 2014 equal to € 1.47 billion for the molecules considered in the analysis. These estimates rise to € 1.54, € 1.50 billion and € 1.51 billion during 2015, 2016 and 2017 in the scenario without biosimilar introduction. Biosimilar introduction generates cost savings between € 3.8 million in 2015 and € 32.9 million in 2017 if compared with the scenario without. Assuming an increasing biosimilar penetration between 2018 and 2020, scenario analysis estimates a cumulative cost reduction equal to € 597 million. Conclusions: Overall, biosimilar penetration generates important cost reduction that could be re-invested in the National Health Sistem.
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Affiliation(s)
- Francesco S Mennini
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
- Institute for Leadership and Management in Health - Kingston University London, London, UK
| | - Andrea Marcellusi
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
- Institute for Leadership and Management in Health - Kingston University London, London, UK
| | - Chiara Bini
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
| | - Maria Assunta Rotundo
- Economic Evaluation and HTA (EEHTA), CEIS, Faculty of Economics, University of Rome Tor Vergata, Rome, Italy
| | - Alessandro Giunta
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, A. Gemelli Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Guido Valesini
- Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, Rome, Italy
| | - Pier Luigi Canonico
- Dipartimento di Pharmaceutical Sciences, Università degli Studi del Piemonte Orientale Amedeo Avogadro
| | - Ettore Novellino
- Director of CIRFF (Centro Interdipartimentale di Ricerca in Farmacoeconomia e Farmacoutilizzazione), University of Naples Federico II, Naples, Italy
| | - Valentina Orlando
- Director of CIRFF (Centro Interdipartimentale di Ricerca in Farmacoeconomia e Farmacoutilizzazione), University of Naples Federico II, Naples, Italy
| | - Alessandra Mecozzi
- Director Pharmaceutical Assistance, ASL (Local Health Authorty) Latina, Latina, Italy
| | | | - Livio Pagano
- Hematology Institute – Polo di Onco-Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eugenio Di Brino
- Alta Scuola di Economia e Management dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Ruggeri
- Alta Scuola di Economia e Management dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Americo Cicchetti
- Alta Scuola di Economia e Management dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
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Aladul MI, Fitzpatrick RW, Chapman SR. Healthcare professionals' perceptions and perspectives on biosimilar medicines and the barriers and facilitators to their prescribing in UK: a qualitative study. BMJ Open 2018; 8:e023603. [PMID: 30455389 PMCID: PMC6252648 DOI: 10.1136/bmjopen-2018-023603] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate UK healthcare professionals' perceptions and perspectives towards biosimilar infliximab, etanercept and insulin glargine and the potential barriers and facilitators to their prescribing. DESIGN A cross-sectional qualitative study design was used. SETTING Five hospitals within the West Midlands area in UK. INTERVENTIONS 30 min face-to-face, semistructured interviews of healthcare professionals. PARTICIPANTS 22 healthcare professionals (consultants, nurses and pharmacists) participated in the semistructured interviews. OUTCOMES Participants' opinion and attitudes about biosimilars and the barriers and facilitators to the prescribing of infliximab, etanercept and insulin glargine biosimilars in gastroenterology, rheumatology and diabetology specialties. RESULTS This study showed that UK healthcare professionals had good knowledge of biosimilars and were content to initiate them. Healthcare professionals disagreed with biosimilar auto-substitution at pharmacy level and multiple switching. Subtle differences among healthcare professionals were identified in the acceptance of switching stable patients, indication extrapolation and cost savings sharing. CONCLUSION Safety and efficacy concerns, patients' opinion and how cost savings were shared were the identified barriers to considering prescribing biosimilars. Real-life data and financial incentives were the suggested facilitators to increase biosimilar utilisation.
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Affiliation(s)
- Mohammed Ibrahim Aladul
- School of Pharmacy, Keele University, Newcastle-Under-Lyme, UK
- School of Pharmacy, University of Mosul, Mosul, Iraq
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Affiliation(s)
- Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Robin Zon
- Michiana Hematology Oncology, Mishawaka, IN
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