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Impact of Infliximab and Etanercept Biosimilars on Biological Disease-Modifying Antirheumatic Drugs Utilisation and NHS Budget in the UK

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Abstract

Objective

Biological disease-modifying antirheumatic drugs (bDMARDs) are effective but expensive options for treating rheumatoid arthritis. The introduction of infliximab and etanercept biosimilars presents a significant potential cost saving in a financially constrained health system such as the National Health Service (NHS) in the UK. This study examines the impact of the introduction of infliximab and etanercept biosimilars on the utilisation of bDMARDs and subsequent budget impact.

Methods

We conducted an interrupted time series analysis of secondary care utilisation data in rheumatology specialities from the DEFINE database, between March 2014 and February 2017.

Results

The cumulative cost savings from the introduction of infliximab and etanercept biosimilars was £38.8 million over 2 years. There was a statistically significant increase in average monthly utilisation of bDMARDs for adalimumab (0.48%), certolizumab pegol (1.90%), golimumab (3.06%), abatacept (2.97%) and tocilizumab (2.24%), but not for etanercept. In contrast, the overall utilisation of infliximab decreased slightly by an average of 0.03% per month. The introduction of infliximab biosimilars negatively affected the monthly utilisation of branded infliximab significantly. Similarly, the introduction of an etanercept biosimilar negatively affected the monthly utilisation of branded etanercept significantly.

Conclusions

The introduction of bDMARDs biosimilars has resulted in considerable cost savings to the NHS, with the branded products reducing their prices in response to the availability of less expensive biosimilars and competition between the biosimilars themselves. Our results also suggest that when a biosimilar is available for a directly comparable branded molecule, price is the key influencing factor in the prescribing of a specific product.

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Acknowledgements

Mohammed Aladul was sponsored by the Higher Committee for Education Development in Iraq.

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Authors and Affiliations

  1. School of Pharmacy, Keele University, Hornbeam Building 3.06, Newcastle-under-Lyme, Staffordshire, ST5 5BG, UK

    Mohammed I. Aladul, Raymond W. Fitzpatrick & Stephen R. Chapman

  2. School of Pharmacy, University of Mosul, Nineveh, Iraq

    Mohammed I. Aladul

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Contributions

All authors have contributed to this study and all authors reviewed and approved the final version of the manuscript. MIA participated in the study design, data collection, and interpretation of results, prepared the manuscript draft, and performed all analytical testing and manuscript review. RWF participated in the study design, interpreted the results and reviewed the manuscript and corrected the final version of the manuscript. SRC designed the study, interpreted the results, reviewed the manuscript and corrected the final version of the manuscript.

Corresponding author

Correspondence to Stephen R. Chapman.

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Funding

This study was not funded by any organisation and the researchers are independent of any funding bodies.

Conflict of interest

Mohammed I. Aladul, Raymond W. Fitzpatrick and Stephen R. Chapman declare that they have no conflict of interest.

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No informed consent was required for this research.

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Aladul, M.I., Fitzpatrick, R.W. & Chapman, S.R. Impact of Infliximab and Etanercept Biosimilars on Biological Disease-Modifying Antirheumatic Drugs Utilisation and NHS Budget in the UK. BioDrugs 31, 533–544 (2017). https://doi.org/10.1007/s40259-017-0252-3

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