AB1276 Economic impact of non-medical switching from originator biologics to biosimilars – a systematic literature review
Authors: Y. Liu, V. Garg, M. Yang, E.Q. Wu, M. Skup
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Biosimilars, often priced at a discounted rate of originator biologics, may prompt switching patients from originator biologics to biosimilars for non-medical reasons. However, other relevant costs (e.g., non-medical switching (NMS) program setup, costs of concomitant therapies, additional healthcare resource utilisation [HRU]) associated with NMS are not well understood. <h3>Objectives</h3> A systematic literature review (SLR) was conducted to review and summarise economic consequences of NMS from a biologic originator to its biosimilar. <h3>Methods</h3> English publications reporting HRU or costs associated with biosimilar NMS were searched in PubMed and Embase over the past 10 years, and from selected scientific conferences over the past 3 years, along with grey literature (e.g., organisational reports). Search strings for keywords (e.g. biosimilar, HRU, cost, switch etc.) were combined using Boolean operators for all relevant agents with an approved biosimilar (e.g., tumor-necrosis factor inhibitors, erythropoiesis-stimulating agents, insulin, hormone therapies). <h3>Results</h3> A total of 244 publications were retrieved for review, where 122 were identified from the database search, 117 from conference abstracts and 5 from grey literature. Of these publications, 23 reported costs or HRU associated with biosimilar NMS, including 10 center-based cohort studies (all except one were single arm), 10 budget impact models/simulation studies, 2 national registry studies, and 1 policy review. Only three studies reported real-world HRU: a single-centre, two-cohort study found that switching to biosimilars was associated with higher inpatient readmission rate (80% vs 5%, p&lt;0.001), surgery rate (29% vs. 0%, p=0.02), and steroid use (60% vs. 8%, p&lt;0.001); a single-centre, single-arm study reported extra visit/phone consultation with a provider among patients experiencing injection-site pain; a national registry-based study found that comparing 6 months before vs. after NMS, post-NMS had increased outpatient visit days (5.7 vs 5.4, p&lt;0.001) and increased rates in 6/16 service categories. Among the other 20 studies, most of them focused on potential cost savings with approximately half considering drug cost only. Estimation/simulation in cost savings varied substantially due to heterogeneity in study design and assumptions (e.g. disease areas, drug price discount rates, cost components, population size, study period etc.). Among these, discontinuing/switching or switching back to the originator was reported in four studies (rate range: 6%–29%) and biosimilar dosing increase (35%) was reported in one study. A policy review study pointed out that biologic rebates (commonly at 50%) should be taken into account in the context of NMS. <h3>Conclusions</h3> Few real-world studies reported economic consequences of biosimilar NMS and found increased HRU in patients with biosimilar NMS. Studies of cost estimation have been largely limited to drug prices. Comprehensive evaluation on the economic impact of NMS should incorporate all important elements of economic outcomes such as drug price, biologic rebates, HRU, NMS program setup, administration, and monitoring costs. <h3>Acknowledgements</h3> Medical writing support was provided by Jessie Wang of Analysis Group; this support was funded by AbbVie. <h3>Disclosure of Interest</h3> Y. Liu Consultant for: AbbVie, V. Garg Shareholder of: AbbVie, Employee of: AbbVie, M. Yang Employee of: Analysis Group, Inc., which has received consultancy fees from AbbVie, E. Wu Employee of: Analysis Group, Inc., which has received consultancy fees from AbbVie, M. Skup Shareholder of: AbbVie, Employee of: AbbVie