Levelling the playing field: How biosimilars can pave the way to equitable treatment for patients across Europe
Immune-mediated diseases have a huge financial impact on society, in terms of long-term treatment costs and decreased work-related productivity.1 At a regional, country and European level, there are significant differences in access to biologics for patients who meet the criteria for their use.1 So what role can biosimilars play in overcoming access obstacles, where they exist? Here we look at how biosimilars can help provide equitable healthcare, thanks to the substantial value they represent.
A 2019 review by Baumgart et al reported that immune-mediated inflammatory diseases (IMIDs), including rheumatoid arthritis (RA) and inflammatory bowel diseases, such as Crohn’s disease (CD) and ulcerative colitis (UC), are associated with pain, progressive disability and loss of earnings.1 They can also lead to depression and anxiety. While the personal burden of these conditions can be significant, the cost to society, in terms of expensive long-term treatment and decreased productivity, is also substantial.1
The economic impact of IMIDs is felt more acutely because they tend to affect working-age people more than other groups. Peak onset for RA is 40-50 years of age, while that for UC and CD is 20-40 years of age.1
Biological therapies are an effective treatment for IMIDs, but their high costs lead to inequities in their use, depending on geographical location. Many countries restrict access to them, even if professional guidelines recommend them.1
The Baumgart review further reported that adoption of biologics by healthcare providers has been especially low in several Central and Eastern European countries.1 One way to grant broader access to IMID patients, is to promote the use of biosimilars in place of reference products.1 Biosimilars are generally less expensive and are approved on the basis that they are similar to the reference product in terms of quality, safety and efficacy.1 The resulting cost savings could help increase access to innovative treatments for more patients.1
Economic benefits of biosimilars
The economic benefits of the introduction of biosimilars, write Baumgart et al, can be seen across Europe. The authors cite, for example, a national tender process in Norway that saw a price reduction of 69% negotiated for the biosimilar infliximab compared to the reference product.1 Additionally, in the United Kingdom, the introduction of the biosimilars infliximab and etanercept resulted in cost savings of £38.8 million over two years (2015-2017).1
The review also cites a model assessing the budget impact of an infliximab biosimilar, in which the annual projected cost savings were estimated to range from €25.79 million (assuming a 10% price reduction) to €77.37 million (30% price reduction) across Belgium, Germany, Italy, Netherlands, and the United Kingdom.1 A similar model estimated that the introduction of an etanercept biosimilar would save the National Health Service in Italy €90 million over 5 years.1
In CD, the total potential cost savings that could be achieved over three years after the introduction of an infliximab biosimilar in Bulgaria, the Czech Republic, Hungary, Poland, Romania, and Slovakia, according to a budget impact model, were expected to be between €8 million (if switching was not allowed) up to €16.9 million (if switching was allowed in 80% of patients).1
Following the recent launch of four adalimumab biosimilars, even greater cost benefits were anticipated, with NHS England estimating that £300 million would be saved by 2021.1
Benefits for patients, healthcare providers and payers
Such savings as we have seen above, the review explains, can be used to improve access to biological treatments for eligible patients, or be allocated to other therapy areas.1 Patients are becoming more willing to switch from reference products to biosimilars, at least partly because they are beginning to appreciate the wider societal benefits.1 Payers can benefit from potential short-term savings and expanded patient access, which can also translate into long-term savings: treating patients with biologics – thanks to the use of biosimilars – at an earlier disease stage may avoid costly hospitalisations and surgical interventions.1
Looking to the future
To ensure the uptake of biosimilars continues to increase, and is equitable across Europe, any remaining negative physician and patient perceptions must be overcome. These can be approached by further raising of awareness and providing tailored education to the different audiences.1 In the case of healthcare professionals, real-world data can also be very persuasive.1 Logistical barriers may also need overcoming, such as ensuring the infrastructure is in place for distributing biosimilars.1 In addition, the role of specialist nurses is very important in this arena, as they are ideally placed to screen and educate patients, coordinate home drug delivery, and monitor and collect data.1
1. 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. doi: 10.3389/fphar.2019.00279.