Nonmedical Switching to Biosimilar in Stable Rheumatic Diseases Associated With Considerable Short-Term Costs

In the short term, nonmedical switching (NMS) of stable patients with a rheumatic condition from originator biologics to biosimilars could have “considerable” short-term costs for a rheumatology medical center, according to a study by Allan Gibofsky, MD, and colleagues that was presented at the annual European Congress of Rheumatology, held June 13-16, 2018, in Amsterdam.

The overall short-term costs associated with NMS were estimated to be £84,174 ($111,246) for the entire center; on average, that is a cost of £147 ($194) per switched patient.

The study estimated costs associated with NMS for stable patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) from the perspective of a rheumatology medical center in the United Kingdom. The researchers constructed an economic model using unit costs associated with provider/staff time and laboratory imaging tests derived from a literature search, and estimated both administrative burden for NMS program set-up and support and provider burden for initiating and managing NMS.

• Administrative burden was modeled at the center level and considered staff time for program set up, patient education, scheduling, documentation, and departmental meetings from pre-NMS planning to post-NMS implementation (< 1 year). Model inputs came from the literature.
• Provider burden was modeled at the patient level and considered (based on physician surveys) the expected additional provider time needed and extra laboratory/imaging tests when managing NMS from the time of switching until 3 months post-NMS implementation.

The study estimated that setting up an NMS program and subsequent administrative support costs £19,617 ($25,921) per center, which was attributed to:

• General overhead (40%)
• Pharmacist time (26%)
• Consultant time (21%)
• Nurse time (13%)

After NMS set-up, provider burden for initiating and managing the switch was estimated to be £113 ($149) per switched patient. Assuming 5000 patients with relevant rheumatoid conditions in a medical center, it was estimated that 572 stable patients with RA, PsA, or AS would switch to biosimilars. The overall short-term cost associated with NMS was estimated to be £84,174 ($111,246) for the entire center, with 23% attributed to the NMS program set-up and support, and 77% attributed to extra provider time and monitoring (on average, a cost of £147 [$194] per switched patient).

Further study of costs related to NMS are needed to better weigh potential savings versus costs associated with NMS.

The researchers disclosed relationships with AbbVie and other pharmaceutical companies.

Reference

Gibofsky A, Garg V, Yang M, Qi CZ, Skup M. Estimating the short-term costs associated with non-medical switching in rheumatic diseases. Presented at the European League Against Rheumatism’s Annual European Congress of Rheumatology, June 13-16, 2018; Amsterdam, Netherlands. Abstract AB0416. doi: 10.1136/annrheumdis-2018-eular.7463.