Does Including Biosimilars Earlier in the Treatment Pathways Lead to Cost Savings in Rheumatology?

OBJECTIVES: To review whether the use of biosimilars earlier in the treatment pathways increases cost savings for the system.

METHODS: Originator and biosimilar drugs approved for Rheumatoid Arthritis (RA) were sourced from the EMA and NICE database. Three drugs, each representing a different mode of action (MOA), were selected: Rinvoq (JAK Inhibitor), Kineret (Interleukin), and Benepali (etanercept biosimilar). Cost-effectiveness analyses and current guidelines for RA patient pathways were obtained from the NICE and EULAR websites.

A targeted literature review focused on the availability of data regarding the cost-effectiveness of including biosimilars earlier in RA treatment pathways, specifically after methotrexate failure or intolerance in Europe. The search strategy combined disease-specific keywords (e.g., 'rheumatoid arthritis' and 'early arthritis'), mode of action keywords (e.g., 'Disease Modifying Anti-Rheumatic Drugs,' 'JAK inhibitor,' 'interleukin,' and 'biosimilars'), drug-specific keywords ('Benepali,' 'Rinvoq,' and 'Kineret'), and economic keywords (e.g., 'cost,' 'healthcare cost,' and 'cost of illness'). English language studies were considered, and the search was limited to Europe.

RESULTS: Six studies were included in the TLR and findings indicate that biosimilars and their originator molecules exhibit a minimal quality of life difference, despite significant cost variations in treatment sequences.

Based on the findings from the review Benepali is associated with the lowest costs and the most cost-effective treatment sequence including all three modes of action, is Benepali -> Rinvoq -> Kineret.

CONCLUSIONS: The TLR indicates that initiating the treatment sequence with a biosimilar drug (after methotrexate failure) is the most cost-efficient approach compared to starting with originator biologics, unless there is a substantial price decrease for biologic drugs. All analyses found that, early inclusion of biosimilars in the RA treatment pathway can result in significant cost savings for the healthcare system. These savings can then be redirected towards reimbursing innovative medicines or financing subsequent treatments if earlier lines fail.