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Mroczek DK, Hauner K, Greene GJ, Kaiser K, Peipert JD, Golf M, Kircher S, Shaunfield S, Lylerohr M, Cella D. Obstacles to Biosimilar Acceptance and Uptake in Oncology: A Review. JAMA Oncol 2024:2819238. [PMID: 38814582 DOI: 10.1001/jamaoncol.2024.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Importance Biosimilar drugs provide cost-effective yet clinically indistinguishable replications of target drugs. During initial development, this class of biologic medicines was expected to revolutionize pharmaceutical markets; however, following US Food and Drug Administration approval of the first biosimilar drug in 2015, the commercialization of biosimilars has been limited. The lack of biosimilar use may be especially salient in oncology, given that biosimilar distribution in this particularly high-cost area of medicine would bring savings on the order of many billions of dollars. Observations While researchers have focused on salient economic barriers to biosimilar uptake in the US, the present review provides insight regarding noneconomic barriers. This review discusses psychological, attitudinal, and educational factors among both health care professionals and payers in the US that may play a role in slowing biosimilar uptake. More specifically, these factors include a lack of health care professional education, concerns of safety and efficacy, and overly complex product naming systems. Conclusions and Relevance The pathway to biosimilar use has been obstructed by economic elements as well as attitudinal and psychological factors. For biosimilar drugs to achieve their potential in decreasing treatment costs and thus increasing patient access, it will be essential for both economic and noneconomic factors to be identified and systematically addressed.
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Affiliation(s)
- Daniel K Mroczek
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, Illinois
| | - Katherina Hauner
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- The Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - George J Greene
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Karen Kaiser
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John Devin Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mary Golf
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sheetal Kircher
- Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sara Shaunfield
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Madison Lylerohr
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Zhu Y, Li C, Chen L, Liu H, Ou L, Li T, Wang X, Wang T, Tian J, Liang X, Hu Z, Zhan Y, Xiao S, Wang X, Li Y, He J, Zheng Q, Song H, Li X, Fang Y. A Phase I Clinical Study Comparing the Pharmacokinetics, Safety, and Immunogenicity of GB221 Injection and Trastuzumab (Herceptin ®) in Healthy Chinese Adults. Eur J Drug Metab Pharmacokinet 2024:10.1007/s13318-024-00889-1. [PMID: 38564097 DOI: 10.1007/s13318-024-00889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND OBJECTIVE GB221 is a recombinant humanized anti-HER2 monoclonal antibody. The purpose of this study was to evaluate the pharmacokinetic, safety, and immunogenicity of GB221 in healthy Chinese adults in comparison to trastuzumab (Herceptin®). METHODS In this randomized, double-blind, parallel-group phase I clinical trial, 88 subjects were randomized 1:1 to receive a single intravenous infusion (90-100 min) of GB221 or trastuzumab (6 mg/kg). The primary pharmacokinetic parameters-maximum observed serum concentration (Cmax), area under the serum concentration-time curve from zero to the last quantifiable concentration at time t (AUC0-t), and area under the serum concentration-time curve from time zero to infinity (AUC0-∞)-of GB221 and trastuzumab were compared to establish whether the 90% confidence interval (CI) attained the 80-125% bioequivalence standard. Safety and immunogenicity were also evaluated. RESULTS The GB221 group (n = 43) and the trastuzumab group (n = 44) showed similar pharmacokinetic characteristics. The geometric mean ratios (90% CI) of Cmax, AUC0-t, and AUC0-∞ between the two groups were 107.53% (102.25-113.07%), 108.31% (103.57-113.26%), and 108.34% (103.57-113.33%), respectively. The incidence of treatment-emergent adverse events (TEAEs) was 83.7% (36/43) of the subjects in the GB221 group and 95.5% (42/44) of the subjects in the trastuzumab group. No subjects withdrew from the trial due to TEAEs, and there were no occurrences of serious adverse events. All subjects tested negative for antidrug antibodies (ADA). CONCLUSION GB221 demonstrated similar pharmacokinetics to trastuzumab and comparable safety and immunogenicity in healthy Chinese adults.
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Affiliation(s)
- Yu Zhu
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Chen Li
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Liming Chen
- Clinical Trial Institution Research Ward, Peking University People's Hospital, Beijing, China
| | - Haiyan Liu
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Lun Ou
- Beijing United-Power Pharma Tech Co., Ltd., Beijing, China
| | - Tong Li
- Department of Clinical Development, Genor Biopharma Co., Ltd., Shanghai, China
| | - Xuan Wang
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Tenghua Wang
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Jingyuan Tian
- Scientific Research Center, Guangzhou Medical University, Guangzhou, China
| | - Xintong Liang
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Zhiqin Hu
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Yaoxuan Zhan
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Shuangshuang Xiao
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Xiaole Wang
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Yongmei Li
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Jin He
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Qingshan Zheng
- The Center for Drug Clinical Research of Shanghai University of TCM, Shanghai, China
| | - Haifeng Song
- State Key Laboratory of Proteomics, Beijing Proteome Research Center, National Center for Protein Sciences (Beijing), Beijing Institute of Lifeomics, Beijing, China.
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, Beijing, 100039, China.
| | - Xianbo Li
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China.
| | - Yi Fang
- Phase I Clinical Research Center, Key Laboratory of Biological Targeting Diagnosis, Therapy and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China.
- Clinical Trial Institution Research Ward, Peking University People's Hospital, Beijing, China.
- Department of Pharmacy, People's Hospital of Peking University, Beijing, 101109, China.
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Liu Y, Bao Y, Huang Y, Zhang M, Li X. How the National Health Insurance Coverage policy changed the use of lenvatinib for adult patients with advanced hepatocellular carcinoma: a retrospective cohort analysis with real world big data. Int J Equity Health 2023; 22:256. [PMID: 38082426 PMCID: PMC10712128 DOI: 10.1186/s12939-023-02052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND To establish a long-term mechanism to control the cost burden of drugs, the Chinese government organized seven rounds of price negotiations for the national reimbursement drug list (NRDL) from 2016 to the end of 2022. The study aimed to evaluate the impact of the National Health Insurance Coverage (NHIC) policy on the use of lenvatinib as the first-line treatment for advanced hepatocellular carcinoma (HCC) within a specific medical insurance region from the micro perspective of individual patient characteristics. METHODS The data of HCC patients that received lenvatinib from September 2019 to August 2022 was retrieved from the Medical and Health Big Data Center and longitudinally analyzed. Contingency table chi-square statistics and binary logistic regression analysis were used to compare the differences in the categorical variables. Interrupted time-series (ITS) regression analysis was performed to evaluate the changes in the utilization of lenvatinib over 36 months. Multiple linear regression was used to analyze the impact of receiving lenvatinib on the total hospitalization expenses of hospitalized patients with advanced HCC. RESULTS A total of 12,659 patients with advanced HCC were included in this study. The usage rate of lenvatinib increased from 6.19% to 15.28% over 36 months (P < 0.001). By controlling the other factors, consistent with this, the probability of patients with advanced HCC receiving lenvatinib increased by 2.72-fold after the implementation of the NHIC policy (OR = 2.720, 95% CI:2.396-3.088, P < 0.001). Older, residency in rural areas, lack of fixed income, treatment at hospitals below the tertiary level, and coverage by urban-rural residents' basic medical insurance (URRBMI) were the factors affecting the use of lenvatinib among patients with advanced HCC (P < 0.05). After the implementation of the NHIC policy, the total hospitalization expenses increased (Beta=-0.040, P < 0.001). However, compared to patients who received lenvatinib, the total hospitalization expenses were higher for those who did not receive the drug (US$5022.07 ± US$5488.70 vs. US$3701.63 ± US$4330.70, Beta = 0.062, P < 0.001). CONCLUSIONS The NHIC policy has significantly increased the utilization of lenvatinib. In addition, we speculate that establishing multi-level medical insurance systems for economically disadvantaged patients would be beneficial in improving the effectiveness of the NHIC policy in the real world.
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Affiliation(s)
- Yanyan Liu
- Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yuwen Bao
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yaxin Huang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Mengdie Zhang
- Department of Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Xin Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
- Department of Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, China.
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.
- Nanjing Medical University, No.101 Longmian Avenue, Jiangning District, Nanjing, Jiangsu, P.R. China.
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Luo X, Du X, Li Z, Liu J, Lv X, Li H, Guo Q, Wang C, Xue X, Le K, Jiang X, Huang L, Yang Y. Clinical Benefit, Price, and Uptake for Cancer Biosimilars vs Reference Drugs in China: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2337348. [PMID: 37824143 PMCID: PMC10570888 DOI: 10.1001/jamanetworkopen.2023.37348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/21/2023] [Indexed: 10/13/2023] Open
Abstract
Importance The high cost of biologics used to treat cancer has been an increasing burden in the world. In China, the recent approval of cancer biosimilar drugs to resolve this problem is promising, but evidence of clinical benefits, price, and uptake for these drugs is still lacking. Objectives To compare characteristics of pivotal clinical trials in China and other countries for biosimilars of bevacizumab, rituximab, and trastuzumab and investigate the efficacy or effectiveness, safety, and immunogenicity outcomes of cancer biosimilars compared with reference drugs by meta-analysis. Data Sources For this systematic review and meta-analysis, PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched for published studies from database inception to February 1, 2023, using the search topics (cancers) AND (biosimilars). Study Selection Randomized clinical trials and cohort studies that included patients with cancer were included. Data Extraction and Synthesis Two authors independently extracted the outcome estimates and characteristics for each study. A random-effects meta-analysis was performed to summarize the relative estimates with 95% CIs. This study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Main Outcomes and Measures Clinical trial characteristics were collected for biosimilars of bevacizumab, rituximab, and trastuzumab. The relative estimates of efficacy or effectiveness (objective response rate, progression-free survival, and overall survival), safety, and immunogenicity outcomes were analyzed for biosimilars vs reference drugs. The weighted average price and uptake rate were evaluated for biosimilars relative to their reference drugs between 2015 and 2022. Results A total of 39 RCTs (involving 18 791 patients) and 10 cohort studies (involving 1998 patients) were included. The biosimilars of bevacizumab (16 RCTs; risk ratio [RR], 0.97; 95% CI, 0.93-1.01; P = .17), rituximab (12 RCTs; RR, 1.03; 95% CI, 0.98-1.08; P = .70), and trastuzumab (9 RCTs: RR, 1.04; 95% CI, 0.97-1.12; P = .29) met equivalence with reference biologics in regard to the objective response rate. The results summarized from cohort studies were consistent with those from RCTs. In 2022, cancer biosimilars were priced at 69% to 90% of the costs for the reference drugs, and their uptake reached 54% to 83% in China. Conclusions and Relevance This systematic review and meta-analysis indicated that cancer biosimilars provided comparable clinical benefits at lower prices compared with reference drugs. These findings suggest the potential feasibility of expediting the transition from reference drugs to biosimilars to benefit more patients with cancer.
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Affiliation(s)
- Xingxian Luo
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China
- Tsinghua-Peking Center for Life Sciences, Beijing, China
| | - Xin Du
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China
| | - Zhuangqi Li
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China
| | - Jingwen Liu
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China
| | - Xufeng Lv
- Center for Drug Evaluation, National Medical Products Administration, Beijing, China
| | - Haoran Li
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
| | - Qixiang Guo
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China
| | - Cen Wang
- School of Life Sciences, Fudan University, Shanghai, China
| | - Xuecai Xue
- Department of Pharmacy, Peking University People’s Hospital, Beijing, China
| | - Kaidi Le
- Department of Pharmacy, Cancer Institute & Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaomeng Jiang
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China
| | - Lin Huang
- Department of Pharmacy, Peking University People’s Hospital, Beijing, China
| | - Yue Yang
- School of Pharmaceutical Sciences, Tsinghua University, Beijing, China
- Key Laboratory of Innovative Drug Research and Evaluation, National Medical Products Administration, Beijing, China
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Fasseeh AN, Elezbawy B, El-Fass KA, GamaI M, Seyam A, Hayek N, Abdel Rahman N, Abdelhamid S, Fasseeh N, Saad AS, Elagamy A, Mahmoud A, Sedrak AS, Elshazly K, Eldebeiky M, Talaat M, Mohamed NM, Abdelaziz RA, Refaat R, Akeel S, Abaza S, Kaló Z. Maximizing the benefits of using biosimilars in Egypt. J Pharm Policy Pract 2023; 16:79. [PMID: 37365620 DOI: 10.1186/s40545-023-00581-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Biosimilars constitute a pathway for sustainable financing of healthcare systems in the era of expensive biologics. However, such a pathway is not free of challenges. Since the biosimilars market is expanding in Egypt, there is an urgent need for a policy framework to optimize their use and diffusion in the market. We aim to characterize a national framework based on the experiences of other countries and consultation with local experts. METHODS A narrative literature review was conducted to identify biosimilars' policy elements worldwide. A workshop was organized with experts to discuss the narrative review findings and create consensus on recommendations. RESULTS The narrative literature review highlighted the need for biosimilar policy actions in four areas: market authorization, pricing, reimbursement, and uptake. Eighteen experts representing the Egyptian healthcare authorities attended the workshop. The most significant conclusions from the workshop included setting the price of the biosimilar at 30-40% less than its originator's price and establishing financing protocols, in which the more expensive biologics with significant price premiums should be excluded from the formulary. CONCLUSIONS A summarized national framework policy recommendation for biosimilars was created by local experts from the main public healthcare entities in Egypt. These recommendations coincide with the international policies adopted across different countries that aim to improve patient access while sustaining health expenditure.
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Affiliation(s)
- Ahmad Nader Fasseeh
- Syreon Middle East, Alexandria, Egypt.
- Faculty of Pharmacy, Alexandria University, Alexandria, Egypt.
| | | | | | - Mary GamaI
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Ahmed Seyam
- Universal Health Insurance Authority, Cairo, Egypt
| | - Noha Hayek
- Theodor Bilharz Research Institute, Giza, Egypt
| | | | | | - Nader Fasseeh
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Ahmed Elagamy
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | - Amal Samir Sedrak
- Universal Health Insurance Authority, Cairo, Egypt
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Mariam Eldebeiky
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | | | | | - Remonda Refaat
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Shaimaa Akeel
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | - Zoltán Kaló
- Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
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Lasala R, Abrate P, Zovi A, Santoleri F. Safety and Effectiveness of Multiple Switching Between Originators and Biosimilars: Literature Review and Status Report on Interchangeability. Ther Innov Regul Sci 2023; 57:352-364. [PMID: 36322326 DOI: 10.1007/s43441-022-00473-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/14/2022] [Indexed: 02/09/2023]
Abstract
To date, numerous biosimilars are available in Europe and the practice of switching between originator and biosimilar or between two different biosimilars has become very widespread. However, multiple switching has not been adequately studied. The aim of this study is to conduct a literature review to assess the effectiveness and safety of multiple switches. All PubMed articles involving multiple switches from originator to biosimilars or between different biosimilars were considered. The relevant data on effectiveness and safety were extracted from these studies and the results were reported through descriptive analysis. Fifteen studies were considered, of which 11 were observational and 4 clinical trials. Inflammatory bowel disease and psoriasis were the most studied diseases. All studies reported that the effectiveness and safety in patients whose treatment involved multiple switches, was comparable to patients whose treatment involved a single or no switch at all. Some therapeutic fields such as oncology and renal insufficiency were not represented at all in the multiple switch studies. New evidence is desperately needed and should be made available to the scientific community and decision-makers.
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Joshi D, Khursheed R, Gupta S, Wadhwa D, Singh TG, Sharma S, Porwal S, Gauniyal S, Vishwas S, Goyal S, Gupta G, Eri RD, Williams KA, Dua K, Singh SK. Biosimilars in Oncology: Latest Trends and Regulatory Status. Pharmaceutics 2022; 14:pharmaceutics14122721. [PMID: 36559215 PMCID: PMC9784530 DOI: 10.3390/pharmaceutics14122721] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Biologic-based medicines are used to treat a variety of diseases and account for around one-quarter of the worldwide pharmaceutical market. The use of biologic medications among cancer patients has resulted in substantial advancements in cancer treatment and supportive care. Biosimilar medications (or biosimilars) are very similar to the reference biologic drugs, although they are not identical. As patent protection for some of the most extensively used biologics begins to expire, biosimilars have the potential to enhance access and provide lower-cost options for cancer treatment. Initially, regulatory guidelines were set up in Europe in 2003, and the first biosimilar was approved in 2006 in Europe. Many countries, including the United States of America (USA), Canada, and Japan, have adopted Europe's worldwide regulatory framework. The use of numerous biosimilars in the treatment and supportive care of cancer has been approved and, indeed, the count is set to climb in the future around the world. However, there are many challenges associated with biosimilars, such as cost, immunogenicity, lack of awareness, extrapolation of indications, and interchangeability. The purpose of this review is to provide an insight into biosimilars, which include various options available for oncology, and the associated adverse events. We compare the regulatory guidelines for biosimilars across the world, and also present the latest trends and challenges in medical oncology both now and in the future, which will assist healthcare professionals, payers, and patients in making informed decisions, increasing the acceptance of biosimilars in clinical practice, increasing accessibility, and speeding up the health and economic benefits associated with biosimilars.
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Affiliation(s)
- Deeksha Joshi
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Rubiya Khursheed
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, India
| | - Saurabh Gupta
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | - Diksha Wadhwa
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, India
| | | | - Sumit Sharma
- Delhi Pharmaceutical Sciences and Research University, New Delhi 110017, India
| | - Sejal Porwal
- Department of Pharmaceutical Sciences, Amity University Lucknow, Lucknow 226028, India
| | - Swati Gauniyal
- Department of Pharmacology, KLE College of Pharmacy, Hubballi 580031, India
| | - Sukriti Vishwas
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, India
| | - Sanjay Goyal
- Department of Internal Medicine, Government Medical College, Patiala 147001, India
| | - Gaurav Gupta
- School of Pharmacy, Suresh Gyan Vihar University, Mahal Road, Jagatpura 333031, India
- Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 602117, India
- Uttaranchal Institute of Pharmaceutical Sciences, Uttaranchal University, Dehradun 248007, India
| | - Rajaraman D. Eri
- School of Science, STEM College, RMIT University, Melbourne, VIC 3001, Australia
- Correspondence: (R.D.E.); (S.K.S.); Tel.: +61-3-6324-5467 (R.D.E.); +91-9888720835 (S.K.S.)
| | - Kylie A. Williams
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Kamal Dua
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara 144411, India
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, NSW 2007, Australia
- Correspondence: (R.D.E.); (S.K.S.); Tel.: +61-3-6324-5467 (R.D.E.); +91-9888720835 (S.K.S.)
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Budget Impact Analysis of the Introduction of a Trastuzumab Biosimilar for HER2-Positive Breast Cancer in China. Clin Drug Investig 2022; 42:937-947. [DOI: 10.1007/s40261-022-01197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/25/2022]
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9
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Birkner B, Blankart KE. The Effect of Biosimilar Prescription Targets for Erythropoiesis-Stimulating Agents on the Prescribing Behavior of Physicians in Germany. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1528-1538. [PMID: 35525830 DOI: 10.1016/j.jval.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to aid decision makers by analyzing the impact of introducing biosimilar prescription targets on physician prescribing behavior in the prescription of biologic erythropoiesis-stimulating agents in Germany. METHODS We combined secondary data of regional level biosimilar prescription targets and secondary data of routinely collected claims data of dispensed prescriptions by physicians operating within the statutory health insurance system in ambulatory care across 7 German regions from 2009 to 2015. Two-way fixed-effects regression analysis was used to identify the average treatment effect of introducing biosimilar prescription targets at the physician level. The main outcome of interest was the share of biosimilar prescriptions on all prescriptions within the substance group. We compared 6 regions that introduced biosimilar prescription targets with 1 region without any prescription target policy. RESULTS Introducing biosimilar prescription targets increased the average share of biosimilars between 6 percentage points (P < .05) in Hamburg and up to 20 percentage points (P < .001) in Saxony-Anhalt. Stratification of specialists by prescription volume and adoption status indicated heterogeneous effects. We identified similar but higher effects for high-volume prescribers. Disentangling of effects with regard to the composition of biosimilar share suggested that the increase in biosimilar share was driven by increased biosimilar use accompanied by a nonsignificant decrease in original biologics prescriptions. CONCLUSIONS Prescription targets to alter physician prescribing behavior meet their intended goals by increasing biosimilar share. Physicians partly responded to the policy by decreasing overall prescriptions of the target substance. Prescription targets might be a useful tool, but decision makers need to consider all aspects of potential responses.
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Affiliation(s)
- Benjamin Birkner
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany.
| | - Katharina E Blankart
- Faculty of Business Administration and Economics/CINCH Health Economics Research Center, Universität Duisburg-Essen, Duisburg, Germany
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10
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Systematic Review on the Use of Biosimilars of Trastuzumab in HER2+ Breast Cancer. Biomedicines 2022; 10:biomedicines10082045. [PMID: 36009592 PMCID: PMC9405693 DOI: 10.3390/biomedicines10082045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Trastuzumab is a monoclonal antibody used in the treatment of breast cancer in cases where the tumor overexpresses the HER2 receptor, a cell membrane receptor activated by the epidermal growth factor. Intravenous and subcutaneous administration of trastuzumab have comparable clinical and pharmacological characteristics, but trastuzumab biosimilars are currently only available in intravenous form. Trastuzumab biosimilars are ultimately preferred by a proportion of patients, especially in cases where co-administration of other chemotherapeutic agents, such as trastuzumab and tucatinib, a small molecule of tyrosine kinase inhibitor, is required in patients with HER-positive metastatic breast cancer. Oncologists should be well-aware of the advantages of intravenously administered trastuzumab biosimilars over subcutaneous administration, certainly also taking into account the patient’s preferences. Further cost-effectiveness analyses will be very important, along with expectations regarding successful concomitant subcutaneous administration of trastuzumab with other anticancer drugs, such as pertuzumab. This systematic review describes and analyzes the so-far published studies concerning the use of the available trastuzumab biosimilars in HER-positive early and metastatic breast cancer in terms of efficacy, safety, and cost–benefit ratio. An attempt was also made to draw some conclusions and to comment on future needs and perspectives.
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11
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Giaccone L, Brunello L, Londono JS, Scaldaferri M, Cerrano M, Redoglia V, Omedè P, Lia G, Massaia M, Ferrero D, Cavallo F, Bringhen S, Leone S, Cattel F, Francisci T, Tassi V, Evangelista A, Boccadoro M, Bruno B. Cost efficiency and effectiveness of biosimilar filgrastim in autologous transplant. Bone Marrow Transplant 2021; 57:312-314. [PMID: 34848834 DOI: 10.1038/s41409-021-01541-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Luisa Giaccone
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy. .,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.
| | - Lucia Brunello
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Jaime Suarez Londono
- Division of Hematology and Medical Oncology, Perlmutter Cancer Center, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Matilde Scaldaferri
- Pharmacy, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Cerrano
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Valter Redoglia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Paola Omedè
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Giuseppe Lia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Massimo Massaia
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Dario Ferrero
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Federica Cavallo
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Sara Bringhen
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Sarah Leone
- Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Francesco Cattel
- Pharmacy, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Tiziana Francisci
- Blood bank and immunohematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Valter Tassi
- Blood bank and immunohematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Andrea Evangelista
- Unit of clinical epidemiology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy
| | - Mario Boccadoro
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Benedetto Bruno
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, University of Torino, Torino, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,Division of Hematology and Medical Oncology, Perlmutter Cancer Center, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
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12
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Resende HM, Ladislau L, Cardoso ACF, Brandão JDP, Assis BR, Cardoso P, Marassi PHA, Castilho V. Biosimilar Use in Breast Cancer Treatment: A National Survey of Brazilian Oncologists' Opinions, Practices, and Concerns. JCO Glob Oncol 2021; 7:1316-1324. [PMID: 34415791 PMCID: PMC8457873 DOI: 10.1200/go.20.00649] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Breast cancer is the most common malignancy in Brazilian women, with 66,280 new cases in 2020 (with 20% overexpressing human epidermal growth factor receptor 2 [HER2]). The trastuzumab biosimilar was the first oncology biosimilar approved in Brazil for HER2-positive breast cancer treatment. This study aimed to assess the current level of knowledge of biosimilars, comfort of use, extrapolation indications, and switching of practices among oncologists in Brazil. METHODS A 24-question survey was developed using an online platform that sought information regarding responders' characteristics and use of biosimilars. The survey analyzed the basic knowledge of biosimilars, trastuzumab biosimilars, level of comfort with extrapolation, switching treatment regimens, and opinions concerning the cost of HER2-positive breast cancer therapy. Data were collected between July and September 2019 and included 144 oncologists from five Brazilian regions. RESULTS In total, 95% of respondents could identify the most appropriate definition of biosimilars and 96% felt comfortable prescribing trastuzumab biosimilars. Although 63% of respondents would use the biosimilar in all settings wherein the reference biologic was approved, 35% would use the biosimilar for cases involving metastatic disease. Although 82% of oncologists were in favor of switching from a reference biologic to a biosimilar, 18% would avoid switching regimens. The lack of studies detailing switching to other regimens and the correct timing to switch was the major concern. The cost of HER2 therapy was a significant concern for most oncologists. CONCLUSION Oncologists demonstrated a high level of knowledge of biosimilars and encouraging levels of prescriber use; however, extrapolation and switching treatment regimens are barriers to the effective use of biosimilars in cancer treatment. Efforts should be concentrated on strategies involving medical education programs on biosimilars.
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Affiliation(s)
- Heloísa M Resende
- Hospital Hinja, Volta Redonda, Rio de Janeiro, Brazil.,Departamento de Clínica Médica, Centro Universitário UNIFOA, Volta Redonda, Rio de Janeiro, Brazil
| | | | | | | | - Biazi R Assis
- Departamento de Clínica Cirúrgica, Centro Universitário UNIFOA, Volta Redonda, Rio de Janeiro, Brazil
| | - Paola Cardoso
- Departamento de Clínica Médica, Centro Universitário UNIFOA, Volta Redonda, Rio de Janeiro, Brazil
| | - Pedro Henrique A Marassi
- Departamento de Clínica Médica, Centro Universitário UNIFOA, Volta Redonda, Rio de Janeiro, Brazil
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13
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Rathore AS, Stevenson JG, Chhabra H, Maharana C. The global landscape on interchangeability of biosimilars. Expert Opin Biol Ther 2021; 22:133-148. [PMID: 33567923 DOI: 10.1080/14712598.2021.1889511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Biosimilars hold the potential to be an integral healthcare component that can significantly improve affordability and thereby accessibility of the otherwise expensive biotherapeutic products. Regulators, payors, and policymakers, each have a major role to play in successful adoption of biosimilars. One of the issues that has been a point of frequent discussion is that of interchangeability of biosimilars. AREAS COVERED This article aims to review the position that the major regulatory bodies have taken on interchangeability of biosimilars. Key issues that remain are also discussed. Adalimumab and etanercept have been chosen as real-world case studies to demonstrate interchangeability considerations. The need for gaining global harmonization on interchangeability is highlighted. EXPERT OPINION A global harmonization on the interchangeability can likely accelerate biosimilar adoption and result in better accessibility to biologics. Experience gained with real-world studies supports switching to biosimilars from originators however post-marketing pharmacovigilance should be in place to assess the risk-benefit profile of biosimilars in the long run.
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Affiliation(s)
- Anurag S Rathore
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
| | - James G Stevenson
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, Ann Arbor, USA
| | - Hemlata Chhabra
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
| | - Chinmoyee Maharana
- Department of Chemical Engineering, Indian Institute of Technology, Delhi, India
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14
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Guidotti E, Vinci B, Attanasio F, Vola F. Effective tools to manage biosimilars prescription: The Italian experience. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Waller CF, Möbius J, Fuentes-Alburo A. Intravenous and subcutaneous formulations of trastuzumab, and trastuzumab biosimilars: implications for clinical practice. Br J Cancer 2021; 124:1346-1352. [PMID: 33589773 PMCID: PMC8039027 DOI: 10.1038/s41416-020-01255-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open
Abstract
Trastuzumab is a biologic therapy indicated for the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer and metastatic gastric cancer. Trastuzumab was originally approved as an intravenous (IV) formulation but has since been developed for subcutaneous (SC) administration for patients with HER2-positive breast cancer. Both formulations demonstrate generally comparable pharmacological and clinical profiles. Therefore, when deciding between treatment options, factors such as the route of administration, patient preference, value and cost must be considered. Studies comparing IV with SC trastuzumab indicate that each formulation offers unique advantages to patients depending on their individual needs. Concurrent with the development of SC trastuzumab, IV trastuzumab biosimilars comprise another treatment option that, in view of their reduced cost, might improve patient access and increase cost-effectiveness for healthcare providers and payers. In this review, we seek to raise awareness of the current options available for trastuzumab so that healthcare providers can optimally treat patients according to their individual situations and preferences.
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Affiliation(s)
- Cornelius F Waller
- Department of Haematology, Oncology and Stem Cell Transplantation, University Medical Centre Freiburg and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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16
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Moorkens E, Godman B, Huys I, Hoxha I, Malaj A, Keuerleber S, Stockinger S, Mörtenhuber S, Dimitrova M, Tachkov K, Vončina L, Palčevski VV, Achniotou G, Slabý J, Popelková L, Kohoutová K, Bartels D, Laius O, Martikainen JE, Selke GW, Kourafalos V, Magnússon E, Einarsdóttir R, Adams R, Joppi R, Allocati E, Jakupi A, Viksna A, Greičiūtė-Kuprijanov I, Vella Bonanno P, Suttorp V, Melien Ø, Plisko R, Mardare I, Meshkov D, Novakovic T, Fürst J, Zara C, Marković-Peković V, Grubiša N, Befrits G, Puckett R, Vulto AG. The Expiry of Humira ® Market Exclusivity and the Entry of Adalimumab Biosimilars in Europe: An Overview of Pricing and National Policy Measures. Front Pharmacol 2021; 11:591134. [PMID: 33519450 PMCID: PMC7839249 DOI: 10.3389/fphar.2020.591134] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Background: From October 2018, adalimumab biosimilars could enter the European market. However, in some countries, such as Netherlands, high discounts reported for the originator product may have influenced biosimilar entry. Objectives: The aim of this paper is to provide a European overview of (list) prices of originator adalimumab, before and after loss of exclusivity; to report changes in the reimbursement status of adalimumab products; and discuss relevant policy measures. Methods: Experts in European countries received a survey consisting of three parts: 1) general financing/co-payment of medicines, 2) reimbursement status and prices of originator adalimumab, and availability of biosimilars, and 3) policy measures related to the use of adalimumab. Results: In May 2019, adalimumab biosimilars were available in 24 of the 30 countries surveyed. Following introduction of adalimumab biosimilars, a number of countries have made changes in relation to the reimbursement status of adalimumab products. Originator adalimumab list prices varied between countries by a factor of 2.8 before and 4.1 after loss of exclusivity. Overall, list prices of originator adalimumab decreased after loss of exclusivity, although for 13 countries list prices were unchanged. When reported, discounts/rebates on originator adalimumab after loss of exclusivity ranged from 0% to approximately 26% (Romania), 60% (Poland), 80% (Denmark, Italy, Norway), and 80–90% (Netherlands), leading to actual prices per pen or syringe between €412 (Finland) and €50 – €99 (Netherlands). To leverage competition following entry of biosimilar adalimumab, only a few countries adopted measures specifically for adalimumab in addition to general policies regarding biosimilars. In some countries, a strategy was implemented even before loss of exclusivity (Denmark, Scotland), while others did not report specific measures. Conclusion: Even though originator adalimumab is the highest selling product in the world, few countries have implemented specific policies and practices for (biosimilar) adalimumab. Countries with biosimilars on the market seem to have competition lowering list or actual prices. Reported discounts varied widely between countries.
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Affiliation(s)
- Evelien Moorkens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Iris Hoxha
- Department of Pharmacy, University of Medicine Tirana, Tirana, Albania
| | - Admir Malaj
- Department of Pharmacy, University of Medicine Tirana, Tirana, Albania
| | | | | | | | - Maria Dimitrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | | | - Luka Vončina
- Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | | | | | - Juraj Slabý
- State Institute for Drug Control, Prague, Czechia
| | | | | | | | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
| | - Jaana E Martikainen
- Pharmaceuticals Pricing Board, Ministry of Social Affairs and Health, Helsinki, Finland
| | | | - Vasileios Kourafalos
- National Organization for the Provision of Healthcare Services (EOPYY), Athens, Greece
| | | | | | | | - Roberta Joppi
- Clinical Research and Drug Evaluation Unit, Local Health Authority of Verona, Verona, Italy
| | - Eleonora Allocati
- Mario Negri Institute for Pharmacological Research (IRCCS), Milan, Italy
| | | | - Anita Viksna
- Department of Medicines and Medical Devices, The National Health Service, Riga, Latvia
| | | | - Patricia Vella Bonanno
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | | | - Øyvind Melien
- Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Ileana Mardare
- Public Health and Management Department, Faculty of Medicine, "Carol Davila", University of Medicine and Pharmacy Bucharest, Bucharest, Romania
| | - Dmitry Meshkov
- V. A. Trapeznikov Institute of Control Sciences of Russian Academy of Sciences, Moscow, Russia
| | | | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Corinne Zara
- Drug Area, Catalan Health Service, Barcelona, Spain
| | - Vanda Marković-Peković
- Department of Social Pharmacy and Pharmacy Practice, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Nataša Grubiša
- Health Insurance Fund, Banja Luka, Bosnia and Herzegovina
| | | | - Robert Puckett
- NHS Greater Glasgow and Clyde, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.,Erasmus University Medical Center, Rotterdam, Netherlands
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17
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Abstract
Introduction: Little is known about market access to biosimilars from a health economic perspective, except for studies that compute the budget impact of biosimilar use. Areas covered: This comprehensive health economic guide to the market access of biosimilars focuses on the role of biosimilars in pharmaceutical innovation and competition, the objective of biopharmaceutical policy, the budget impact of biosimilars, and the cost-effectiveness of biologic therapy in the presence of biosimilars. Expert opinion: We argue that the objective of biopharmaceutical policy in a health system should be to create a competitive and sustainable market for off-patent reference biologics, biosimilars, and next-generation biologics that makes biologic therapy available to patients at the lowest cost. Market access of biosimilars can contribute to this objective as a result of the lower price of biosimilars and price competition with alternative therapies. The resulting improvement in the cost-effectiveness of biologic therapy needs to be accounted for by revisiting reimbursement decisions and conditions. When examining the cost-effectiveness of biologic therapy following patent expiry, stakeholders need to consider residual uncertainties at the time of biosimilar marketing authorization, the nocebo effect, market entry of a second-generation reference biologic with a different administration form than the biosimilar, and value-added services.
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Affiliation(s)
- Steven Simoens
- 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, Erasmus University Medical Center , Rotterdam, The Netherlands
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18
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Bennett CL, Schoen MW, Hoque S, Witherspoon BJ, Aboulafia DM, Hwang CS, Ray P, Yarnold PR, Chen BK, Schooley B, Taylor MA, Wyatt MD, Hrushesky WJ, Yang YT. Improving oncology biosimilar launches in the EU, the USA, and Japan: an updated Policy Review from the Southern Network on Adverse Reactions. Lancet Oncol 2021; 21:e575-e588. [PMID: 33271114 DOI: 10.1016/s1470-2045(20)30485-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 12/12/2022]
Abstract
The EU, the USA, and Japan account for the majority of biological pharmacotherapy use worldwide. Biosimilar regulatory approval pathways were authorised in the EU (2006), in Japan (2009), and in the USA (2015), to facilitate approval of biological drugs that are highly similar to reference products and to encourage market competition. Between 2007 and 2020, 33 biosimilars for oncology were approved by the European Medicines Agency (EMA), 16 by the US Food and Drug Administration (FDA), and ten by the Japan Pharmaceuticals and Medical Devices Agency (PMDA). Some of these approved applications were initially rejected because of manufacturing concerns (four of 36 [11%] with the EMA, seven of 16 [44%] with the FDA, none of ten for the PMDA). Median times from initial regulatory submission before approval of oncology biosimilars were 1·5 years (EMA), 1·3 years (FDA), and 0·9 years (PMDA). Pharmacists can substitute biosimilars for reference biologics in some EU countries, but not in the USA or Japan. US regulation prohibits substitution, unless the biosimilar has been approved as interchangeable, a designation not yet achieved for any biosimilar in the USA. Japan does not permit biosimilar substitution, as prescribers must include the product name on each prescription and that specific product must be given to the patient. Policy Reviews published in 2014 and 2016 in The Lancet Oncology focused on premarket and postmarket policies for oncology biosimilars before most of these drugs received regulatory approval. In this Policy Review from the Southern Network on Adverse Reactions, we identify factors preventing the effective launch of oncology biosimilars. Introduction to the market has been more challenging with therapeutic than for supportive care oncology biosimilars. Addressing region-specific competition barriers and educational needs would improve the regulatory approval process and market launches for these biologics, therefore expanding patient access to these products in the EU, the USA, and Japan.
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Affiliation(s)
- Charles L Bennett
- College of Pharmacy, University of South Carolina, Columbia, SC, USA; WJB Dorn VA Medical Center, Columbia, SC, USA; Department of Comparative Medicine and Evidence Based Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
| | - Martin W Schoen
- Saint Louis University School of Medicine, Saint Louis, MO, USA; John Cochran VA Medical Center, Saint Louis, MO, USA
| | - Shamia Hoque
- College of Engineering and Computing, University of South Carolina, Columbia, SC, USA; WJB Dorn VA Medical Center, Columbia, SC, USA
| | | | | | | | - Paul Ray
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Paul R Yarnold
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Brian K Chen
- The Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; WJB Dorn VA Medical Center, Columbia, SC, USA
| | - Benjamin Schooley
- College of Engineering and Computing, University of South Carolina, Columbia, SC, USA
| | - Matthew A Taylor
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Michael D Wyatt
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | | | - Y Tony Yang
- School of Nursing and Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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19
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Cortes J, Perez-García JM, Llombart-Cussac A, Curigliano G, El Saghir NS, Cardoso F, Barrios CH, Wagle S, Roman J, Harbeck N, Eniu A, Kaufman PA, Tabernero J, García-Estévez L, Schmid P, Arribas J. Enhancing global access to cancer medicines. CA Cancer J Clin 2020; 70:105-124. [PMID: 32068901 DOI: 10.3322/caac.21597] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Globally, cancer is the second leading cause of death, with numbers greatly exceeding those for human immunodeficiency virus/acquired immunodeficiency syndrome, tuberculosis, and malaria combined. Limited access to timely diagnosis, to affordable, effective treatment, and to high-quality care are just some of the factors that lead to disparities in cancer survival between countries and within countries. In this article, the authors consider various factors that prevent access to cancer medicines (particularly access to essential cancer medicines). Even if an essential cancer medicine is included on a national medicines list, cost might preclude its use, it might be prescribed or used inappropriately, weak infrastructure might prevent it being accessed by those who could benefit, or quality might not be guaranteed. Potential strategies to address the access problems are discussed, including universal health coverage for essential cancer medicines, fairer methods for pricing cancer medicines, reducing development costs, optimizing regulation, and improving reliability in the global supply chain. Optimizing schedules for cancer therapy could reduce not only costs, but also adverse events, and improve access. More and better biomarkers are required to target patients who are most likely to benefit from cancer medicines. The optimum use of cancer medicines depends on the effective delivery of several services allied to oncology (including laboratory, imaging, surgery, and radiotherapy). Investment is necessary in all aspects of cancer care, from these supportive services to technologies, and the training of health care workers and other staff.
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Affiliation(s)
- Javier Cortes
- IOB Institute of Oncology, Quironsalud Group, Madrid, Spain
- IOB Institute of Oncology, Quironsalud Group, Hospital Quiron, Barcelona, Spain
- Medica Scientia Innovation Research, Barcelona, Spain
- Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Jose Manuel Perez-García
- IOB Institute of Oncology, Quironsalud Group, Hospital Quiron, Barcelona, Spain
- Medica Scientia Innovation Research, Barcelona, Spain
| | | | | | - Nagi S El Saghir
- Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Carlos H Barrios
- Oncology Research Center, Hospital Sao Lucas, Porto Alegre, Brazil
| | | | - Javier Roman
- Breast Unit, Gastrointestinal Tumor Unit and Lung Tumor Unit, IOB Institute of Oncology, Quironsalud Group, Madrid, Spain
| | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology, University of Munich (LMU), Munich, Germany
| | | | | | - Josep Tabernero
- IOB Institute of Oncology, Quironsalud Group, Hospital Quiron, Barcelona, Spain
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, CIBERONC, Barcelona, Spain
| | | | - Peter Schmid
- Center of Experimental Cancer Medicine, Barts Cancer Institute, St. Bartholomew Breast Cancer Center, St. Bartholomew's Hospital, London, United Kingdom
| | - Joaquín Arribas
- Preclinical Research Program, Vall d'Hebron Institute of Oncology, Barcelona, Spain
- Biomedical Research Oncology Network (CIBERONC), Barcelona, Spain
- Department of Biochemistry and Molecular Biology, Autonomous University of Barcelona, Bellaterra, Spain
- Catalan Institution for Research and Advanced Studies, (ICREA), Barcelona, Spain
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Tesar T, Golias P, Inotai A, Kawalec P, Wawruch M. The impact of implemented regulations on biosimilars in Slovakia. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Different Policy Measures and Practices between Swedish Counties Influence Market Dynamics: Part 1-Biosimilar and Originator Infliximab in the Hospital Setting. BioDrugs 2019; 33:285-297. [PMID: 30945207 PMCID: PMC6533410 DOI: 10.1007/s40259-019-00345-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Decentralisation of healthcare budgets and issuance of local guidelines means that the use of biosimilars can vary by region within a particular country, for example between the 21 counties of Sweden. Objectives This study aimed to analyse the county-level market dynamics of biosimilar and originator infliximab, which are hospital products, and to examine how local policy measures and practices, in addition to national policy, influenced market dynamics. Methods We first conducted a literature review on (biosimilar) policies in Sweden, then analysed market data provided by IQVIA™ on uptake of originator and biosimilar infliximab within the different counties (Q2 2012 to Q4 2017), including discounts from (tender) contracts. Biosimilar market shares were calculated with volume data (measured as defined daily doses [DDDs]). We then discussed our findings in semi-structured interviews with the national pricing and reimbursement agency, key experts within the county councils of Skåne, Västra Götaland, and Stockholm, and an industry representative. Results Market shares of biosimilar infliximab vary widely between counties (range 18–96% in 2017). The initial uptake of biosimilar infliximab was slow and variable, with abrupt increments in biosimilar market shares coinciding with expiration of contracts for the originator product. Different approaches taken by counties to achieve a low cost per DDD of infliximab were identified, i.e., a rapid switch to the biosimilar (Skåne), a delayed switch to the biosimilar (Stockholm), or no switch to the biosimilar when a favourable price on the originator product could be obtained (Västra Götaland). Quantitative analysis showed that 59% of the variability in biosimilar market shares could be explained by the relative difference in discounted price between the biosimilar and the originator product. In addition, qualitative analysis indicated the presence of key opinion leaders, local guidelines and initiatives, and whose budget it affects as drivers in the decision-making process. Conclusions Variations in the market share of biosimilar infliximab between the Swedish counties is largely explained by the discounted price difference between biosimilar and originator product, and counties used different strategies to leverage such biosimilar competition. Additionally, the presence of key opinion leaders, local guidelines and gainsharing arrangements appeared to play a role in infliximab market dynamics in counties.
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Anderson KC, Landgren O, Arend RC, Chou J, Jacobs IA. Humanistic and economic impact of subcutaneous versus intravenous administration of oncology biologics. Future Oncol 2019; 15:3267-3281. [DOI: 10.2217/fon-2019-0368] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
More oncology biologics are becoming available for subcutaneous (sc.) administration and are expected to provide useful therapeutic options. We evaluated evidence published in the past 5 years to assess the humanistic and economic impact of sc. versus intravenous administration of approved cancer therapies and identify outcomes favoring either administration route. These publications focused predominantly on healthcare resource utilization and economic outcomes, demonstrating resource and cost savings with sc. administration. Patients reported a better health-related quality of life and preference for sc. formulations. Time-and-motion study analyses confirmed the convenience of sc. administration. These findings suggest that future availability of sc. oncology biologics, especially anti-PD-1/PD-ligand 1 antibodies due to their increased utility in various malignancies, may be beneficial for patients, healthcare providers and payers.
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Affiliation(s)
- Kenneth C Anderson
- Division of Hematologic Neoplasia, Harvard Medical School, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Ola Landgren
- Myeloma Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Rebecca C Arend
- University of Alabama at Birmingham, Comprehensive Cancer Center, Experimental Therapeutics Program, Birmingham, AL 35294, USA
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Krendyukov A, Schiestl M. Biosimilars in oncology: A decade of experience with granulocyte colony-stimulating factor and its implications for monoclonal antibodies. Crit Rev Oncol Hematol 2019:102785. [PMID: 31405784 DOI: 10.1016/j.critrevonc.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/24/2018] [Accepted: 07/10/2019] [Indexed: 12/15/2022] Open
Abstract
Biosimilars offer the potential for improved sustainability of cancer care. In oncology, granulocyte colony-stimulating factor and erythropoiesis-stimulating agent biosimilars have been available for almost a decade, with biosimilars of monoclonal antibodies a more recent development. Sandoz biosimilar filgrastim was approved based on Phase III confirmatory studies conducted in patients with breast cancer experiencing chemotherapy-induced neutropenia, with other indications granted based on extrapolation. Despite the fact that extrapolation is a well-established scientific principle in regulation of biological medicines, it is a commonly misunderstood part of the biosimilar concept. Broad experience from almost a decade of use of Sandoz biosimilar filgrastim includes >21 million patient-days exposure and >9 years of real-world clinical evidence, indicates extrapolation successfully at work. Together, this can help reassure oncologists that extrapolation is based on sound scientific principles. Efforts to improve understanding of extrapolation are critical to ensure the acceptance of future oncology biosimilar monoclonal antibodies.
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Affiliation(s)
- Andriy Krendyukov
- Former employee of HEXAL AG, Industriestr. 25, D-83607, Holzkirchen, Germany.
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Public perspectives on disinvestments in drug funding: results from a Canadian deliberative public engagement event on cancer drugs. BMC Public Health 2019; 19:977. [PMID: 31331312 PMCID: PMC6647147 DOI: 10.1186/s12889-019-7303-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 07/10/2019] [Indexed: 11/16/2022] Open
Abstract
Background Decisions relating to the funding of new drugs are becoming increasingly challenging due to a combination of aging populations, rapidly increasing list prices, and greater numbers of drug-indication pairs being brought to market. This is especially true in cancer, where rapid list price inflation is coupled with steeply rising numbers of incident cancer cases. Within a publicly funded health care system, there is increasing recognition that resource allocation decisions should consider the reassessment of, and potential disinvestment from, currently funded interventions alongside new investments. Public input into the decision-making process can help legitimize the outcomes and ensure priority-setting processes are aligned with public priorities. Methods In September 2014, a public deliberation event was held in Vancouver, Canada, to obtain public input on the topic of cancer drug funding. Twenty-four members of the general public were tasked with making collective recommendations for policy-makers about the principles that should guide funding decisions for cancer drugs in the province of British Columbia. Deliberative questions and decision aids were used to elicit individuals’ willingness to make trade-offs between expenditures and health outcomes. Results Participants discussed the implications of disinvestment decisions from cancer drugs in terms of its impact on patient choice, fairness and quality of life. Their discussions indicate that in order for a decision to disinvest from currently-funded cancer drugs to be acceptable, it must align with three main principles: the decision must be accompanied by significant gains, described both in terms of cost savings and opportunities to re-invest elsewhere in the health care system; those who are currently prescribed a cancer drug should be allowed to continue their course of treatment (referred to as a continuance clause, or “grandfathering” approach); and it must consider how access to care for specialized populations is impacted. Conclusions The results from this deliberation event provide insight into what is acceptable to British Columbians with respect to disinvestment decisions for cancer drugs. These recommendations can be considered within wider health system decision-making frameworks for funding decisions relating to all drugs, as well as for cancer drugs.
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Harbeck N, Wang J, Otto GP, Gattu S, Krendyukov A. Safety analysis of proposed pegfilgrastim biosimilar in Phase I and Phase III studies. Future Oncol 2019; 15:1313-1322. [DOI: 10.2217/fon-2018-0878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Aim: This analysis compares safety data for Sandoz proposed biosimilar (LA-EP2006) and reference pegfilgrastim from a Phase I pharmacokinetic/pharmacodynamic study in healthy volunteers (HVs) and two Phase III confirmatory studies in patients with breast cancer (BC; total n = 808). Patients & methods: Baseline characteristics were summarized, and event rates of bone pain and headache calculated. Results: HVs in the Phase I pharmacokinetic/pharmacodynamic study were generally younger, with lower mean body mass index, versus BC patients in PROTECT-1/-2. Bone pain was the most frequent adverse event with similar incidences with reference versus proposed biosimilar in all studies. Conclusion: No differences in adverse events were found between Sandoz proposed biosimilar and reference pegfilgrastim, notwithstanding some differences between HVs and BC patients.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology, University of Munich (LMU), Munich 81377, Germany
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26
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Chen B, Nagai S, Armitage JO, Witherspoon B, Nabhan C, Godwin AC, Yang YT, Kommalapati A, Tella SH, DeAngelis C, Raisch DW, Sartor O, Hrushesky WJ, Ray PS, Yarnold PR, Love BL, Norris LB, Knopf K, Bobolts L, Riente J, Luminari S, Kane RC, Hoque S, Bennett CL. Regulatory and Clinical Experiences with Biosimilar Filgrastim in the U.S., the European Union, Japan, and Canada. Oncologist 2019; 24:537-548. [PMID: 30842244 DOI: 10.1634/theoncologist.2018-0341] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/14/2018] [Indexed: 11/17/2022] Open
Abstract
Biosimilar filgrastims are primarily indicated for chemotherapy-induced neutropenia prevention. They are less expensive formulations of branded filgrastim, and biosimilar filgrastim was the first biosimilar oncology drug administered in European Union (EU) countries, Japan, and the U.S. Fourteen biosimilar filgrastims have been marketed in EU countries, Japan, the U.S., and Canada since 2008, 2012, 2015, and 2016, respectively. We reviewed experiences and policies for biosimilar filgrastim markets in EU countries and Japan, where uptake has been rapid, and in the U.S. and Canada, where experience is rapidly emerging. U.S. regulations for designating biosimilar interchangeability are under development, and such regulations have not been developed in most other countries. Pharmaceutical substitution is allowed for new filgrastim starts in some EU countries and in Canada, but not Japan and the U.S. In EU countries, biosimilar adoption is facilitated with favorable hospital tender offers. U.S. adoption is reportedly 24%, while the second filgrastim biosimilar is priced 30% lower than branded filgrastim and 20% lower than the first biosimilar filgrastim approved by the U.S. Food and Drug Administration. Utilization is about 60% in EU countries, where biosimilar filgrastim is marketed at a 30%-40% discount. In Japan, biosimilar filgrastim utilization is 45%, primarily because of 35% discounts negotiated by Central Insurance and hospital-only markets. Overall, biosimilar filgrastim adoption barriers are small in many EU countries and Japan and are diminishing in Canada in the U.S. Policies facilitating improved U.S. adoption of biosimilar filgrastim, based on positive experiences in EU countries and Japan, including favorable insurance coverage; larger price discount relative to reference filgrastim pricing; closing of the "rebate trap" with transparent pricing information; formal educational efforts of patients, physicians, caregivers, and providers; and allowance of pharmaceutical substitution of biosimilar versus reference filgrastim, should be considered. IMPLICATIONS FOR PRACTICE: We reviewed experiences and policies for biosimilar filgrastims in Europe, Japan, Canada, and the U.S. Postmarketing harmonization of regulatory policies for biosimilar filgrastims has not occurred. Acceptance of biosimilar filgrastims for branded filgrastim, increasing in the U.S. and in Canada, is commonplace in Japan and Europe. In the U.S., some factors, accepted in Europe or Japan, could improve uptake, including acceptance of biosimilars as safe and effective; larger cost savings, decreasing "rebate traps" where pharmaceutical benefit managers support branded filgrastim, decreased use of patent litigation/challenges, and allowing pharmacists to routinely substitute biosimilar for branded filgrastim.
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Affiliation(s)
- Brian Chen
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina, USA
| | - Sumimasa Nagai
- Translational Research Center, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Bartlett Witherspoon
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chadi Nabhan
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Ashley C Godwin
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Y Tony Yang
- Center for Health Policy and Media Engagement, George Washington University, Washington, D.C., USA
| | - Anuhya Kommalapati
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Sri Harsha Tella
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | | | - Dennis W Raisch
- College of Pharmacy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Oliver Sartor
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - William J Hrushesky
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Paul S Ray
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Paul R Yarnold
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Bryan L Love
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - LeAnn B Norris
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Kevin Knopf
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
- Alameda Health System, Oakland, California, USA
| | - Laura Bobolts
- Oncology Analytics Inc., Plantation, Florida, USA
- Nova Southeastern University College of Pharmacy, Fort Lauderdale, Florida, USA
| | - Joshua Riente
- William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina, USA
| | - Stefano Luminari
- Hematology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Robert C Kane
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Shamia Hoque
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Charles L Bennett
- South Carolina Center of Economic Excellence for Medication Safety, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina, USA
- William Jennings Bryan Dorn VA Medical Center, Columbia, South Carolina, USA
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Inotai A, Ágh T, Karpenko AW, Zemplényi A, Kaló Z. Behind the subcutaneous trastuzumab hype: evaluation of benefits and their transferability to Central Eastern European countries. Expert Rev Pharmacoecon Outcomes Res 2018; 19:105-113. [DOI: 10.1080/14737167.2019.1554437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- András Inotai
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy and Health Economics, Eötvös Loránd University (ELTE), Budapest, Hungary
| | - Tamás Ágh
- Syreon Research Institute, Budapest, Hungary
| | - Alexei Willem Karpenko
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Antal Zemplényi
- Syreon Research Institute, Budapest, Hungary
- Department of Pharmacoeconomics, University of Pécs, Pécs, Hungary
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy and Health Economics, Eötvös Loránd University (ELTE), Budapest, Hungary
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Santos SB, Sousa Lobo JM, Silva AC. Biosimilar medicines used for cancer therapy in Europe: a review. Drug Discov Today 2018; 24:293-299. [PMID: 30244082 DOI: 10.1016/j.drudis.2018.09.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/31/2018] [Accepted: 09/13/2018] [Indexed: 12/26/2022]
Abstract
This article provides an updated review of the biosimilar medicines approved for cancer therapy in the European Union (EU). First we discuss the most relevant aspects for the development and approval of biosimilar medicines. We then present the oncological biosimilar drugs currently used, which include epoetins (alpha and zeta), filgrastim, and monoclonal antibodies (rituximab, trastuzumab and bevacizumab). Among the clinical applications of biosimilar medicines, cancer therapy remains the main target area and more approved biosimilars are expected over the next few years, providing cost-effective drugs to more patients. Furthermore, comprehensive pharmacovigilance studies are going on, monitoring the marketed biosimilars, and providing more feasible information to clinicians regarding the safety and efficacy of these medications.
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Affiliation(s)
- Sofia B Santos
- UFP Energy, Environment and Health Research Unit (FP-ENAS), Fernando Pessoa University, Porto, Portugal
| | - José M Sousa Lobo
- UCIBIO, ReQuimTe, Laboratory of Pharmaceutical Technology/Centre of Research in Pharmaceutical Sciences, Faculty of Pharmacy, Porto University, Porto, Portugal
| | - Ana C Silva
- UFP Energy, Environment and Health Research Unit (FP-ENAS), Fernando Pessoa University, Porto, Portugal; UCIBIO, ReQuimTe, Laboratory of Pharmaceutical Technology/Centre of Research in Pharmaceutical Sciences, Faculty of Pharmacy, Porto University, Porto, Portugal.
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29
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O'Callaghan J, Barry SP, Bermingham M, Morris JM, Griffin BT. Regulation of biosimilar medicines and current perspectives on interchangeability and policy. Eur J Clin Pharmacol 2018; 75:1-11. [PMID: 30187103 DOI: 10.1007/s00228-018-2542-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/13/2018] [Indexed: 01/23/2023]
Abstract
Competition arising from the increasing availability of biosimilar medicines has resulted in healthcare savings and has provided greater patient access to high cost therapeutics in Europe. The biosimilar market in the USA is relatively new so the full impact of biosimilar availability remains to be seen. Educational initiatives relating to the use of biosimilar medicines are currently being undertaken by regulators, policy makers and industry. The debate on biosimilars has moved on from the appropriateness of the regulatory framework which governs their approval, to the practice of interchangeability. Interchangeability is an important issue for healthcare professionals but different definitions and regulatory frameworks exist in the USA and Europe. In the USA, an interchangeable biological product is a biosimilar which may be substituted by a pharmacist, subject to local State policies. The interchangeability of a biosimilar with its reference medicine will be evaluated by the United States Food and Drug Administration (FDA) in cases where approval as an 'interchangeable product' is sought. In contrast, the European Medicines Agency (EMA) does not assess or make recommendations on interchangeability, therefore, in Europe, interchangeability does not mean substitution but is generally physician-led or driven by national policy. This paper provides an overview of the regulation of biosimilar medicines. Challenges associated with the demonstration of interchangeability and practical considerations relating to switching are also discussed. Finally, we present policies that have been adopted to date in several European countries, the USA and Australia, which aim to promote the use of biosimilar medicines.
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Affiliation(s)
- J O'Callaghan
- Regulatory Science Ireland, c/o School of Pharmacy, University College Cork, Cork, Ireland.,School of Pharmacy, University College Cork, Cork, Ireland.,Health Products Regulatory Authority, Kevin O'Malley House, Earlsfort Centre, Earlsfort Terrace, Dublin 2, Ireland
| | - S P Barry
- Health Products Regulatory Authority, Kevin O'Malley House, Earlsfort Centre, Earlsfort Terrace, Dublin 2, Ireland.
| | - M Bermingham
- School of Pharmacy, University College Cork, Cork, Ireland
| | - J M Morris
- Regulatory Science Ireland, c/o School of Pharmacy, University College Cork, Cork, Ireland
| | - B T Griffin
- Regulatory Science Ireland, c/o School of Pharmacy, University College Cork, Cork, Ireland.,School of Pharmacy, University College Cork, Cork, Ireland
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Scheinberg M, Pineda C, Castañeda-Hernández G, Zarbá JJ, Damião A, Arantes Jr LH, Jacobs I. Biosimilars in oncology and inflammatory diseases: current and future considerations for clinicians in Latin America. MAbs 2018; 10:827-842. [PMID: 30156950 PMCID: PMC6152448 DOI: 10.1080/19420862.2018.1484977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 05/21/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
Biological therapies have revolutionized the treatment of several cancers and systemic immune-mediated inflammatory conditions. Expiry of patents protecting a number of biologics has provided the opportunity to commercialize highly similar versions, known as biosimilars. Biosimilars are approved by regulatory agencies via an independent pathway that requires extensive head-to-head comparison with the originator product. Biosimilars have the potential to provide savings to healthcare systems and expand patient access to biologics. In Latin American countries, regulatory frameworks for biosimilar approval have been introduced in recent years, and biosimilars of monoclonal antibody and fusion protein therapies are now emerging. However, the situation in this region is complicated by the presence of "non-comparable biotherapeutics" (also known as "intended copies"), which have not been rigorously compared with the originator product. We review the considerations for clinicians in Latin American countries, focusing on monoclonal antibody biosimilars relevant to oncology, rheumatology, gastroenterology, and dermatology.
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Affiliation(s)
- Morton Scheinberg
- Rheumatology Section – Orthopedics Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Gilberto Castañeda-Hernández
- Department of Pharmacology, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Mexico City, Mexico
| | - Juan José Zarbá
- Oncology Department, Hospital Centro de Salud Zenón J. Santillán, San Miguel de Tucumán, Argentina
- Facultad de Medicina, Universidad Nacional de Tucumán, San Miguel de Tucumán, Argentina
| | - Aderson Damião
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil
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31
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Motola D, Vaccheri A, Roncadori A, Donati M, Bonaldo G, Covezzoli A, Polidori P, Bianchi S. Comparative risk/benefit profile of biosimilar and originator erythropoiesis-stimulating agents (ESAs): data from an Italian observational study in nephrology. Eur J Clin Pharmacol 2018; 74:805-810. [PMID: 29429032 DOI: 10.1007/s00228-018-2428-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 02/01/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this multicenter prospective study was to evaluate efficacy and safety of biosimilar erythropoiesis-stimulating agents (ESAs) vs originator, based on data from clinical practice in patients with chronic kidney disease (CKD). METHODS We collected data of the patients with diagnosis of CKD on conservative treatment from nine Italian structures. Patients were enrolled applying different exclusion criteria, and various individual parameters were registered at the beginning for descriptive analysis. Patients were treated with epoetin alfa, beta, and darbepoetin as originator and epoetin zeta as biosimilar. Hemoglobin levels have been analyzed at baseline and after 3, 6, and 12 months. Descriptive statistics were used to analyze the results. RESULTS At baseline, 47 patients were in the biosimilar group and 57 in the originator; the basal level of hemoglobin was similar between the groups (mean Hb 9.4 and 9.3 g/dL, respectively). Median age, weight, and comorbidities were almost comparable. After 3 months, 44 patients remained in the biosimilar group and 48 in the originator; hemoglobin increase was significantly greater in patients treated with biosimilar [absolute increase 1.6 vs 1.0 g/dL, p < 0.001]. After 6 and 12 months, number of patients fall furthermore. Hemoglobin levels increased more in the biosimilar group after 6 months (2.1 vs 1.1 g/dL, p < 0.001) and 12 months (2.0 vs 1.0 g/dL, p < 0.001). CONCLUSIONS Biosimilar ESAs have similar risk/benefit profile compared to originators. Our data are in agreement with relevant scientific literature and, on the other hand, they are in contrast with common thought that considers biosimilar less efficacious and less safe than originators.
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Affiliation(s)
- Domenico Motola
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, via Irnerio 48, 40126, Bologna, Italy.
| | - Alberto Vaccheri
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, via Irnerio 48, 40126, Bologna, Italy
| | - Andrea Roncadori
- CINECA - Interuniversity Consortium - Health Department, via Magnanelli 6/3, 40033, Casalecchio di Reno, BO, Italy
| | - Monia Donati
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, via Irnerio 48, 40126, Bologna, Italy
| | - Giulia Bonaldo
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, via Irnerio 48, 40126, Bologna, Italy
| | - Anna Covezzoli
- CINECA - Interuniversity Consortium - Health Department, via Magnanelli 6/3, 40033, Casalecchio di Reno, BO, Italy
| | - Piera Polidori
- Department of Clinical Pharmacy, Mediterranean Institute for Transplantation and Advanced Specialised Therapies (ISMETT), Palermo, Italy
| | - Stefano Bianchi
- Department of Pharmacy, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
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Affiliation(s)
| | - Matti Aapro
- Multidisciplinary Oncology Institute, Clinique de Genolier, Genolier, Switzerland
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Moorkens E, Vulto AG, Huys I, Dylst P, Godman B, Keuerleber S, Claus B, Dimitrova M, Petrova G, Sović-Brkičić L, Slabý J, Šebesta R, Laius O, Karr A, Beck M, Martikainen JE, Selke GW, Spillane S, McCullagh L, Trifirò G, Vella Bonanno P, Mack A, Fogele A, Viksna A, Władysiuk M, Mota-Filipe H, Meshkov D, Kalaba M, Mencej Bedrač S, Fürst J, Zara C, Skiöld P, Magnússon E, Simoens S. Policies for biosimilar uptake in Europe: An overview. PLoS One 2017; 12:e0190147. [PMID: 29284064 PMCID: PMC5746224 DOI: 10.1371/journal.pone.0190147] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/09/2017] [Indexed: 12/04/2022] Open
Abstract
Background Across European countries, differences exist in biosimilar policies, leading to variations in uptake of biosimilars and divergences in savings all over Europe. Objectives The aim of this article is to provide an overview of different initiatives and policies that may influence the uptake of biosimilars in different European countries. Recommendations will be formulated on how to create sustainable uptake. Methods An overview of policies on biosimilars was obtained via a questionnaire, supplemented with relevant articles. Topics were organized in five themes: availability, pricing, reimbursement, demand-side policies, and recommendations to enhance uptake. Results In all countries studied, biological medicines are available. Restrictions are mainly dependent on local organization of the healthcare system. Countries are willing to include biosimilars for reimbursement, but for commercial reasons they are not always marketed. In two thirds of countries, originator and biosimilar products may be subjected to internal reference pricing systems. Few countries have implemented specific incentives targeting physicians. Several countries are implementing pharmacist substitution; however, the scope and rules governing such substitution tend to vary between these countries. Reported educational policies tend to target primarily physicians, whereas fewer initiatives were reported for patients. Recommendations as proposed by the different country experts ranged from the need for information and communication on biosimilars to competitive pricing, more support for switching and guidance on substitution. Conclusions Most countries have put in place specific supply-side policies for promoting access to biosimilars. To supplement these measures, we propose that investments should be made to clearly communicate on biosimilars and educate stakeholders. Especially physicians need to be informed on the entry and use of biosimilars in order to create trust. When physicians are well-informed on the treatment options, further incentives should be offered to prescribe biosimilars. Gainsharing can be used as an incentive to prescribe, dispense or use biosimilars. This approach, in combination with binding quota, may support a sustainable biosimilar market.
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Affiliation(s)
- Evelien Moorkens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- * E-mail:
| | - Arnold G. Vulto
- Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabelle Huys
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Pieter Dylst
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
- Medicines for Europe, Brussels, Belgium
| | - Brian Godman
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Simon Keuerleber
- Main Association of Austrian Social Security Institutions, Vienna, Austria
| | - Barbara Claus
- Faculty of pharmaceutical sciences, Ghent University, Ghent, Belgium
| | - Maria Dimitrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Guenka Petrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | | | - Juraj Slabý
- State Institute for Drug Control, Prague, Czech Republic
| | - Robin Šebesta
- State Institute for Drug Control, Brno, Czech Republic
| | - Ott Laius
- State Agency of Medicines, Tartu, Estonia
- Department of Traumatology and Orthopedics, University of Tartu, Tartu, Estonia
| | - Allan Karr
- Karr Consultancy Ltd, Hertfordshire, United Kingdom
| | - Morgane Beck
- OMEDIT Alsace, Agence Régionale de Santé du Grand Est, Strasbourg, France
| | | | | | - Susan Spillane
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland
| | - Laura McCullagh
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
- National Centre for Pharmacoeconomics, St James's Hospital, Dublin, Ireland
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Patricia Vella Bonanno
- Strathclyde Institute for Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
| | - Asbjørn Mack
- Division Pharmaceuticals, Norwegian Hospital Procurement Trust, Oslo, Norway
| | - Antra Fogele
- Department of Medicines and Medical Devices, The National Health Service, Riga, Latvia
| | - Anita Viksna
- Department of Medicines and Medical Devices, The National Health Service, Riga, Latvia
| | | | | | - Dmitry Meshkov
- Semashko National Research Institute for Public Health, Moscow, Russia
| | | | - Simona Mencej Bedrač
- Agency for Medicinal Products and Medical Devices of the Republic of Slovenia, Ljubljana, Slovenia
| | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | - Corrine Zara
- Barcelona Health Region, Catalan Health Service, Barcelona, Spain
| | | | | | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
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Lucchesi S, Marcianò I, Panagia P, Intelisano R, Randazzo MP, Sgroi C, Altavilla G, Santarpia M, Adamo V, Franchina T, Ferraù F, Reitano P, Trifirò G. Prevalence of Use and Cost of Biological and Non-Biological Targeted Therapies for Cancer Treatment: A 5-Year Picture from Southern Italy. Clin Drug Investig 2017; 38:269-278. [PMID: 29076054 PMCID: PMC5834595 DOI: 10.1007/s40261-017-0591-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Considering the clinical and economic burden of biological and non-biological targeted therapies in cancer
treatment, it is necessary to explore how these drugs are used in routine care in Italy and how they affect the sustainability of the National Health Services. This study aimed to investigate the prevalence of use and costs of biological and non-biological targeted therapies for cancer treatment in a general population of Southern Italy in the years 2010–2014. METHODS This was a retrospective, observational study using data from the healthcare administrative databases of Messina Province for the years 2010-2014. In this study, users of biological and non-biological targeted therapies for cancer treatment were characterized and the prevalence of use and costs were calculated over time. The potential impact of biosimilars on the expenditure was also estimated. RESULTS Of a population of 653,810 residents in the Messina area during the study years, 2491 (0.4%) patients received at least one study drug. The most frequently used were monoclonal antibodies (mAbs) (n = 1607; 64.5%) and tyrosine kinase inhibitors (TKIs) (n = 609; 24.4%). mAbs were mainly used by females (60.3%) for metastasis due to an unspecified primary tumor, lymphomas, or breast cancer (24.2, 16.7, and 13.7%, respectively). Most users of small molecules were males (56.3%) being treated for multiple myeloma, metastasis due to unspecified primary tumor, leukemia, and lung cancer (13.1, 12.6, 9.5, and 8.9%, respectively). During the study years, the prevalence of use doubled from 0.9 to 1.8 per 1000 inhabitants; likewise, the related expenditure grew from €6.6 to €13.6 million. Based on our forecasts, this expenditure will grow to €25 million in 2020. Assuming a 50% biosimilar uptake (trastuzumab and rituximab), a potential yearly saving of almost €1 million may be achieved. CONCLUSIONS In recent years, the use and costs of biological and non-biological targeted therapies in cancer patients dramatically increased in a large population from Southern Italy. This trend may be counterbalanced by adopting biosimilars once they are available. Claims databases represent a valid tool to monitor the uptake of newly marketed biological drugs and biosimilars as well as other non-biological targeted therapies.
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Affiliation(s)
- Simona Lucchesi
- Department of Chemical Sciences, Biological, Pharmaceutical and Environmental, University of Messina, Messina, Italy
| | - Ilaria Marcianò
- Clinical Pharmacology Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | | | | | | | - Carmela Sgroi
- Pharmaceutical Department, Local Health Unit of Messina, Messina, Italy
| | - Giuseppe Altavilla
- Medical Oncology Unit, Department of Adult and Childhood Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Mariacarmela Santarpia
- Medical Oncology Unit, Department of Adult and Childhood Human Pathology "G. Barresi", University of Messina, Messina, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit, Department of Adult and Childhood Human Pathology "G. Barresi", University of Messina, Messina, Italy
- Medical Oncology Unit, Papardo Hospital, Messina, Italy
| | - Tindara Franchina
- Medical Oncology Unit, Department of Adult and Childhood Human Pathology "G. Barresi", University of Messina, Messina, Italy
- Medical Oncology Unit, Papardo Hospital, Messina, Italy
| | - Francesco Ferraù
- Medical Oncology Unit, Hospital "San Vincenzo", Messina, Taormina, Italy
| | | | - Gianluca Trifirò
- Clinical Pharmacology Unit, A.O.U. Policlinico "G. Martino", Messina, Italy.
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, Messina, Italy.
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.
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Inotai A, Prins CPJ, Csanádi M, Vitezic D, Codreanu C, Kaló Z. Is there a reason for concern or is it just hype? - A systematic literature review of the clinical consequences of switching from originator biologics to biosimilars. Expert Opin Biol Ther 2017. [PMID: 28650704 DOI: 10.1080/14712598.2017.1341486] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION While prescribing biosimilars to patients naive to a biologic treatment is a well-accepted practice, switching clinically stable patients from an originator to a biosimilar is an issue for clinicians. Well-designed clinical trials and real-world data which study the consequences of switching from an originator biologic treatment to its biosimilar alternative are limited, especially for monoclonal antibodies. Areas covered: A systematic literature review was conducted on PubMed to identify evidence of the consequences of switching from original biologics to biosimilars. References of included papers were also scrutinized. After a title-, abstract- and full text screening, out of the 153 original hits and 77 additional ones from screening the references, 58 papers (12 empirical papers, 5 systematic reviews and 41 non-empirical papers) were included. Expert opinion: Preventing patients on biologic medicines from switching to biosimilars due to anticipated risks seems to be disproportional compared to the expected cost savings and/or improved patient access. Indeed, it is the opinion of the authors that the concern of switching to biosimilars is overhyped.
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Affiliation(s)
- András Inotai
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy & Health Economics , Faculty of Social Sciences, Eötvös Loránd University (ELTE) Budapest , Hungary
| | - Christiaan P J Prins
- c Department of Pharmaceutical Sciences , Utrecht University , Utrecht , The Netherlands
| | | | - Dinko Vitezic
- d University of Rijeka School of Medicine and University Hospital Centre Rijeka , Rijeka , Croatia
| | - Catalin Codreanu
- e Center for Rheumatic Diseases , University of Medicine and Pharmacy , Bucharest , Romania
| | - Zoltán Kaló
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy & Health Economics , Faculty of Social Sciences, Eötvös Loránd University (ELTE) Budapest , Hungary
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Vogler S, Paris V, Ferrario A, Wirtz VJ, de Joncheere K, Schneider P, Pedersen HB, Dedet G, Babar ZUD. How Can Pricing and Reimbursement Policies Improve Affordable Access to Medicines? Lessons Learned from European Countries. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:307-321. [PMID: 28063134 DOI: 10.1007/s40258-016-0300-z] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This article discusses pharmaceutical pricing and reimbursement policies in European countries with regard to their ability to ensure affordable access to medicines. A frequently applied pricing policy is external price referencing. While it provides some benchmark for policy-makers and has been shown to be able to generate savings, it may also contribute to delay in product launch in countries where medicine prices are low. Value-based pricing has been proposed as a policy that promotes access while rewarding useful innovation; however, implementing it has proven quite challenging. For high-priced medicines, managed-entry agreements are increasingly used. These agreements allow policy-makers to manage uncertainty and obtain lower prices. They can also facilitate earlier market access in case of limited evidence about added therapeutic value of the medicine. However, these agreements raise transparency concerns due to the confidentiality clause. Tendering as used in the hospital and offpatent outpatient sectors has been proven to reduce medicine prices but it requires a robust framework and appropriate design with clear strategic goals in order to prevent shortages. These pricing and reimbursement policies are supplemented by the widespread use of Health Technology Assessment to inform decision-making, and by strategies to improve the uptake of generics, and also biosimilars. While European countries have been implementing a set of policy options, there is a lack of thorough impact assessments of several pricing and reimbursement policies on affordable access. Increased cooperation between authorities, experience sharing and improving transparency on price information, including the disclosure of confidential discounts, are opportunities to address current challenges.
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Affiliation(s)
- Sabine Vogler
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian Public Health Institute), 1010, Vienna, Austria.
| | - Valérie Paris
- Health Division, Organisation for Economic Co-operation and Development (OECD), 75116, Paris, France
| | - Alessandra Ferrario
- LSE Health and Department of Social Policy, London School of Economics and Political Science, London, WC2A 2AE, UK
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Kees de Joncheere
- Essential Medicines and Health Products Department (EMP), World Health Organization (WHO), 1211, Geneva 27, Switzerland
| | - Peter Schneider
- WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian Public Health Institute), 1010, Vienna, Austria
| | - Hanne Bak Pedersen
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, 2100, Denmark
| | - Guillaume Dedet
- World Health Organization (WHO) Regional Office for Europe, Copenhagen, 2100, Denmark
| | - Zaheer-Ud-Din Babar
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Mail Bag, 92019, Auckland, New Zealand
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21st century pharmacovigilance: efforts, roles, and responsibilities. Lancet Oncol 2017; 17:e486-e492. [PMID: 27819246 DOI: 10.1016/s1470-2045(16)30312-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/30/2016] [Accepted: 07/07/2016] [Indexed: 12/31/2022]
Abstract
In an era when the number of expedited and conditional review pathways for newly available brand-name drugs and biosimilar medicines to treat serious and life-threatening diseases is increasing, defining pharmacovigilance has never been more crucial. 21st century pharmacovigilance is not merely about uncovering, reporting, and addressing adverse events associated with already approved and marketed agents, but can be described as the systematic monitoring of the process of pre-market review and post-market surveillance, which includes the use of medicines in everyday practice. Pharmacovigilance identifies previously unrecognised adverse events or changes in the patterns of these effects, the quality and adequacy of drug supply, and should ensure effective communication with the public, health-care professionals, and patients about the optimum safety and effective use of medicines. In this paper, the first in a Series of three about drug safety in oncology, we discuss evolving challenges in the purview, roles, and responsibilities of the US Food and Drug Administration and the European Medicines Agency with respect to pharmacovigilance efforts, with a special emphasis on oncology treatment.
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The Rituximab Biosimilar CT-P10 in Rheumatology and Cancer: A Budget Impact Analysis in 28 European Countries. Adv Ther 2017; 34:1128-1144. [PMID: 28397080 PMCID: PMC5427122 DOI: 10.1007/s12325-017-0522-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Indexed: 12/20/2022]
Abstract
Introduction New biosimilars of monoclonal antibodies are anticipated to bring significant cost savings and increase access to treatment. The rituximab biosimilar CT-P10 has recently been approved in Europe in all indications held by reference rituximab (RTX), including rheumatoid arthritis, non-Hodgkin’s lymphoma, and chronic lymphocytic leukemia. We analyzed the budgetary impact of the introduction of CT-P10 into the European Union (EU) for use in patients with rheumatoid arthritis and cancer diagnoses, using a budget impact analysis model. Methods The model used a base case scenario in which the 1-year uptake of CT-P10 was estimated at 30%, and the cost of CT-P10 was assumed to be 70% of the cost of RTX. A second 1-year scenario was also modeled, in which the market share of CT-P10 was assumed to be 50% (scenario 2). Finally, 3-year time horizon outcomes were calculated, in which the market share of CT-P10 was assumed to be 30%, 40%, and 50% in the first, second, and third years, respectively. Results In the base case scenario, the introduction of CT-P10 was associated with projected savings of €90.04 million in the first year, which would allow 7531 additional patients to access rituximab treatment. This was equivalent to a 6.4% increase in the number of rituximab-treated patients. In scenario 2, budget savings were €150.10 million, with a total of 12,551 additional patients able to access rituximab, equivalent to a 10.7% increase. Over a 3-year time horizon, projected budget savings were approximately €570 million, equating to 47,695 additional patients able to access rituximab. Conclusions The model predicted that the introduction of CT-P10 in the EU will be associated with significant budget savings, the reallocation of which will enable many more patients to access rituximab treatment. This is likely to have a significant impact on health gains at patient and societal levels. Funding: CELLTRION Healthcare Co., Ltd. sponsored the development and analysis of the budget impact analysis model. Electronic supplementary material The online version of this article (doi:10.1007/s12325-017-0522-y) contains supplementary material, which is available to authorized users.
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Geynisman DM, De Velasco G, Sewell KL, Jacobs I. Biosimilar biologic drugs: a new frontier in medical care. Postgrad Med 2017; 129:460-470. [PMID: 28343424 DOI: 10.1080/00325481.2017.1311196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Physicians in training are expected to be aware of the newest developments in patient care. Biologic therapies have changed treatment of many diseases by specifically targeting key disease mediators, but patient access to these therapies can be limited. As patents for the first biologic therapies are expiring, the development and approval of products known as biosimilars is rapidly gaining momentum. A biosimilar is a biologic product that is highly similar to a reference product (a licensed biologic product), notwithstanding minor differences in clinically inactive components. Biosimilars undergo a thorough evaluation compared with the licensed biologic and need to demonstrate comparable clinical pharmacokinetics, efficacy, and safety including immunogenicity. Understanding the processes for new drug approvals, the rigorous evaluation of biosimilars, and considerations about their selection and use can help recently trained physicians to make informed treatment decisions and improve patient outcomes.
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Affiliation(s)
- Daniel M Geynisman
- a Fox Chase Cancer Center , Temple University Health System , Philadelphia , PA , USA
| | - Guillermo De Velasco
- b Department of Medical Oncology , Dana-Farber Cancer Institute , Boston , MA , USA.,c Department of Medical Oncology , University Hospital 12 de Octubre , Madrid , Spain
| | - K Lea Sewell
- d Biotechnology Clinical Development , Pfizer Inc , Cambridge , MA , USA
| | - Ira Jacobs
- e Global Established Pharma Medicines Development Group , Pfizer Inc , New York , NY , USA
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Ruiz R, Strasser-Weippl K, Touya D, Herrero Vincent C, Hernandez-Blanquisett A, St. Louis J, Bukowski A, Goss PE. Improving access to high-cost cancer drugs in Latin America: Much to be done. Cancer 2017; 123:1313-1323. [DOI: 10.1002/cncr.30549] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Rossana Ruiz
- Instituto Nacional de Enfermedades Neoplásicas; Lima Peru
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
| | | | - Diego Touya
- “Dr. Manuel Quintela” Hospital Clinics; Montevideo Uruguay
| | | | | | - Jessica St. Louis
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
| | - Alexandra Bukowski
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
| | - Paul E. Goss
- Global Cancer Institute; Boston Massachusetts
- Massachusetts General Hospital; Boston Massachusetts
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Rémuzat C, Dorey J, Cristeau O, Ionescu D, Radière G, Toumi M. Key drivers for market penetration of biosimilars in Europe. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2017; 5:1272308. [PMID: 28265349 PMCID: PMC5328350 DOI: 10.1080/20016689.2016.1272308] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background & Objectives: Potential drivers and barriers of biosimilar uptake were mainly analysed through qualitative approaches. The study objective was to conduct a quantitative analysis and identify drivers of biosimilar uptake of all available biosimilars in the European Union (EU). Methods: A three-step process was established to identify key drivers for the uptake of biosimilars in the top 10 EU member states (MS) pharmaceutical markets (Belgium, France, Germany, Greece, Hungary, Italy, Poland, Spain, Sweden, and the UK): (1) literature review to identify incentive policies in place to enhance biosimilars adoption; (2) assessment of biosimilar market dynamics based on database analysis; (3) regression model analysis on price using the following explicative variables: incentive policies; price difference between the biosimilar and the originator product; distribution channel; generic uptake and generic price cut; pharmaceutical expenditure per capita; and market competition. Results: At the study cut-off date, 20 biosimilars were available on the market. Incentive policies applied to biosimilars were found to be heterogeneous across countries, and uptakes of biosimilars were also very heterogeneous between different therapeutic classes and countries. Results from the model demonstrated that incentive policies and the date of first biosimilar market entry were correlated to biosimilar uptake. Pharmaceutical expenditure per capita and the highest generic uptake were inversely correlated with biosimilar uptake. Average generic price discount over originator and the number of biosimilars showed a trend toward statistical significance for correlation with biosimilar uptake, but did not reach the significance threshold. Biosimilar price discount over original biologic price, the number of analogues, and the distribution channel were not correlated with the biosimilar uptake. Conclusions: Understanding drivers of biosimilar uptake becomes a critical issue to inform policy decision-makers. This study showed that incentive policies to enhance uptake remain an important driver of biosimilar penetration, while biosimilar price discounts have no impact. Future research is warranted when the biosimilar market gains maturity.
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Affiliation(s)
- Cécile Rémuzat
- Pricing and Market Access Department, Creativ-Ceutical, Paris, France
| | - Julie Dorey
- HEOR Department, Creativ-Ceutical, Paris, France
| | | | - Dan Ionescu
- Global Pricing and Market Access Biopharmaceuticals Department, Sandoz International GmbH, Holzkirchen, Germany
| | - Guerric Radière
- Global Pricing and Market Access Biopharmaceuticals Department, Sandoz International GmbH, Holzkirchen, Germany
| | - Mondher Toumi
- Faculté de Médecine, Laboratoire de Santé Publique, Aix-Marseille Université, Université de la Méditerranée, Marseille, France
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McConachie S, Wilhelm SM, Kale-Pradhan PB. Biosimilars in Inflammatory Bowel Disease - Accumulating Clinical Evidence. Expert Rev Clin Pharmacol 2017; 10:391-400. [DOI: 10.1080/17512433.2017.1283983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Sean McConachie
- Department of Pharmacy, Harper University Hospital , Detroit, MI, USA
| | - Sheila M. Wilhelm
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University , Detroit, MI, USA
- Harper University Hospital , Detroit, MI, USA
| | - Pramodini B. Kale-Pradhan
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University , Detroit, MI, USA
- St. John Hospital and Medical Center , Detroit, MI, USA
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Rémuzat C, Kapuśniak A, Caban A, Ionescu D, Radière G, Mendoza C, Toumi M. Supply-side and demand-side policies for biosimilars: an overview in 10 European member states. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2017; 5:1307315. [PMID: 28740617 PMCID: PMC5508392 DOI: 10.1080/20016689.2017.1307315] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/08/2017] [Indexed: 05/11/2023]
Abstract
This study aimed to provide an overview of biosimilar policies in 10 EU MSs. Methods: Ten EU MS pharmaceutical markets (Belgium, France, Germany, Greece, Hungary, Italy, Poland, Spain, Sweden, and the UK) were selected. A comprehensive literature review was performed to identify supply-side and demand-side policies in place in the selected countries. Results: Supply-side policies for biosimilars commonly include price linkage, price re-evaluation, and tendering; the use of internal or external reference pricing varies between countries; health technology assessment is conducted in six countries. Regarding demand-side policies, pharmaceutical prescription budgets or quotas and monitoring of prescriptions (with potential financial incentives or penalties) are in place in eight and in seven countries respectively. Switching is generally allowed, but is solely the physician's responsibility. Automatic substitution is not recommended, or even forbidden, in most EU MSs. Prescription conditions or guidelines that apply to biosimilars are established in nearly all surveyed EU MSs. Conclusions: Important heterogeneity in policies on biosimilars was seen between (and even within) selected countries, which may partly explain variations in biosimilar uptake. Supply-side policies targeting price have been reported to limit biosimilar penetration in the long term, despite short-term savings, while demand-side policies are considered to positively impact uptake.
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Affiliation(s)
- Cécile Rémuzat
- Pricing and Market Access Department, Creativ-Ceutical, Paris, France
- CONTACT Cécile Rémuzat Pricing and Market Access Department, Creativ-Ceutical, Paris, France
| | - Anna Kapuśniak
- Pricing and Market Access Department, Creativ-Ceutical, Krakow, Poland
| | - Aleksandra Caban
- Pricing and Market Access Department, Creativ-Ceutical, Krakow, Poland
| | - Dan Ionescu
- Global Pricing and Market Access Biopharmaceuticals Department, Sandoz International GmbH, Holzkirchen, Germany
| | - Guerric Radière
- Global Pricing and Market Access Biopharmaceuticals Department, Sandoz International GmbH, Holzkirchen, Germany
| | - Cyril Mendoza
- Global Pricing and Market Access Biopharmaceuticals Department, Sandoz International GmbH, Holzkirchen, Germany
| | - Mondher Toumi
- Laboratoire de Santé Publique, Aix-Marseille Université, Université de la Méditerranée, Marseille, France
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Morgan SG, Weymann D, Pratt B, Smolina K, Gladstone EJ, Raymond C, Mintzes B. Sex differences in the risk of receiving potentially inappropriate prescriptions among older adults. Age Ageing 2016; 45:535-42. [PMID: 27151390 PMCID: PMC4916346 DOI: 10.1093/ageing/afw074] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/23/2016] [Indexed: 12/21/2022] Open
Abstract
Objectives: to measure sex differences in the risk of receiving potentially inappropriate prescription drugs and to examine what are the factors that contribute to these differences. Design: a retrospective cohort study. Setting: community setting of British Columbia, Canada. Participants: residents of British Columbia aged 65 and older (n = 660,679). Measurements: we measured 2013 period prevalence of prescription dispensations satisfying the American Geriatrics Society's 2012 version of the Beers Criteria for potentially inappropriate medication use in older adults. We used logistic regressions to test for associations between this outcome and a number of clinical and socioeconomic factors. Results: a larger share of women (31%) than of men (26%) filled one or more potentially inappropriate prescription in the community. The odds of receiving potentially inappropriate prescriptions are associated with several clinical and socioeconomic factors. After controlling for those factors, community-dwelling women were at 16% higher odds of receiving a potentially inappropriate prescription than men (adjusted odds ratio = 1.16, 95% confidence interval = 1.12–1.21). Much of this sex difference stemmed from women's increased odds of receiving potentially inappropriate prescriptions for benzodiazepines and other hypnotics, for tertiary tricyclic antidepressants and for non-selective NSAIDs. Conclusion: there are significant sex differences in older adults' risk of receiving a potentially inappropriate prescription as a result of complex intersections between gender and other social constructs. Appropriate responses will therefore require changes in the information, norms and expectations of both prescribers and patients.
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Affiliation(s)
- Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada V6T1Z3
| | - Deirdre Weymann
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada V6T1Z3
| | | | - Kate Smolina
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada V6T1Z3
| | - Emilie J Gladstone
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada V6T1Z3
| | - Colette Raymond
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada
| | - Barbara Mintzes
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
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Smith TJ, Hillner BE. Real-World Conundrums and Biases in the Use of White Cell Growth Factors. Am Soc Clin Oncol Educ Book 2016; 35:e524-7. [PMID: 27249762 DOI: 10.1200/edbk_156062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We present the 2015 American Society of Clinical Oncology (ASCO) white cell growth factors, or colony-stimulating factor (CSF), guidelines, updated from 2006. One new indication has been added-dose-intense chemotherapy for bladder cancer-to accompany the existing use for dose-dense breast cancer chemotherapy. Colony-stimulating factors remain appropriate for any regimen where the risk of febrile neutropenia is about 20% per cycle and dose reduction is not appropriate. Based on new evidence from multiple trials, CSF use is no longer indicated in treatment of lymphoma unless there are special risk factors. The United States accounts for 78% of the sales of CSF. The panel approved the use of all biosimilars, but the cost savings will be small as the price is about 80% of the branded CSFs. More biosimilars at lower cost are awaited. Methods to reduce use without harm to patients, by requiring justification according to accepted guidelines, are ongoing.
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Affiliation(s)
- Thomas J Smith
- From the Harry J. Duffey Family Palliative Care Program of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Hillner Consulting, LLC, Richmond, VA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
| | - Bruce E Hillner
- From the Harry J. Duffey Family Palliative Care Program of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Hillner Consulting, LLC, Richmond, VA; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA
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Abstract
Congress passed the Biologics Price Competition and Innovation Act (BPCI Act) as part of the Affordable Care Act on March 23, 2010. The BPCI Act authorized an approval pathway for biosimilar and interchangeable products. It defines biosimilarity to mean "that the biological product is highly similar to the reference product notwithstanding minor differences in clinically inactive components" and that "there are no clinically meaningful differences between the biological product and the reference product in terms of safety, purity, and potency of the product." The biosimilar pathway has the potential to facilitate access to biologic products through increased competition, in the same manner as biosimilars have done for almost 10 years in Europe. The goal of a biosimilar program is not to independently establish safety and effectiveness for each condition of use. Rather, the goal is to demonstrate biosimilarity through an extensive analytical characterization and a targeted clinical program designed to assess for clinically meaningful differences, if they exist. The regulatory approaches in both the United States and Europe involve a totality-of-the-evidence approach to demonstrate biosimilarity. Importantly, the biosimilar pathway allows for extrapolation of data across indications so that a sponsor, with adequate scientific justification, need not conduct clinical studies in each intended condition of use. Without extrapolation, development may not be feasible for many products, and patients and resources could be diverted from clinical studies of newer agents for cancer.
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Affiliation(s)
- Steven J Lemery
- From the U.S. Food and Drug Administration, Silver Spring, MD; New York University Clinical Cancer Center, New York, NY; Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - Francisco J Esteva
- From the U.S. Food and Drug Administration, Silver Spring, MD; New York University Clinical Cancer Center, New York, NY; Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
| | - Martina Weise
- From the U.S. Food and Drug Administration, Silver Spring, MD; New York University Clinical Cancer Center, New York, NY; Federal Institute for Drugs and Medical Devices (BfArM), Bonn, Germany
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