Budget Analysis of the Implementation of Biosimilars in a Large Private Health Insurance Company in Southern Brazil
Author(s)
Rafael Gama, MD, MBA1, Valderilio Azevedo, PhD2, Paula Heberle, MBA3, Sergio M. Menoncin, Msc3, Daniela Toigo, MBA3, Fabiana Aguiar, PG3, Josymar N. Júnior, MD3, Ana C. Maciel, PG3, Ricardo Bueno, BA, MHA, PhD4;
1RK, Health Economics, CURITIBA, Brazil, 2Universidade Federal Paraná, Clinica Médica, Curitiba, Brazil, 3Unimed Blumenau, Blumenau, Brazil, 4FMU, Graduate Program on Corporate Governance, São Paulo, Brazil
1RK, Health Economics, CURITIBA, Brazil, 2Universidade Federal Paraná, Clinica Médica, Curitiba, Brazil, 3Unimed Blumenau, Blumenau, Brazil, 4FMU, Graduate Program on Corporate Governance, São Paulo, Brazil
Presentation Documents
OBJECTIVES: Objective: To evaluate the pharmaceutical expenditure impact of a managed switch process from reference biologics o Biosimilars based on Real-Word costs in a Brazilian Private Health Plans covering 130,000 lives.
METHODS: METHODS: We develop a budget model and estimate savings switching to biosimilars between Nov/22 to Oct 24 using the payer perspective. The clinical indications for payment and reimbursement were those approved by Brazilian Regulatory Agency for Private Health Insurance and Plans (ANS), in addition to technical evaluation by the insurer's medical audit. The exchange of original molecules for biosimilars followed the agreement of the patient's attending physician. In the first year, only naïve patients received biosimilars, and in the second year there was also a switch in patients who were already using reference biologics. The costs related to treatment were extracted from the payer’s claim database and analyzed with dynamic data panel in MS Excel. Exchange rate R$ 6 per 1 USD. There are no changes on the reimbursement reference list during the analyzed period.
RESULTS: RESULTS: A 2-year cost comparison of infliximab, Adalimumab, Etanercept, Rituximab, Trastuzumab and Bevacizumab biosimilars versus reference biologicals was performed. The total cost avoided in 24 months was USD 1,488,290.73 in 1131 patients/month. Savings per molecule in USD (and quantity of patients / month) was Infliximab USD 318,796.71 (242); Adalimumab USD 897,822.61 (745); Rituximab USD 33,100.98 (2); Etanercept USD 3,404.15 (3); Bevacizumab USD 37,080.80 (121); Trastuzumab USD 198,085.47 (239). The usage of Biosimilars increased from 39% to 80%.
CONCLUSIONS: CONCLUSION: The use of biosimilars in Brazil has been expanded, but entry and acceptance by both prescribers and healthcare providers is still challenging. There is a potential to increase access, relevant cost reduction and financial sustainability for a medium-sized insurance company in Brazil.
METHODS: METHODS: We develop a budget model and estimate savings switching to biosimilars between Nov/22 to Oct 24 using the payer perspective. The clinical indications for payment and reimbursement were those approved by Brazilian Regulatory Agency for Private Health Insurance and Plans (ANS), in addition to technical evaluation by the insurer's medical audit. The exchange of original molecules for biosimilars followed the agreement of the patient's attending physician. In the first year, only naïve patients received biosimilars, and in the second year there was also a switch in patients who were already using reference biologics. The costs related to treatment were extracted from the payer’s claim database and analyzed with dynamic data panel in MS Excel. Exchange rate R$ 6 per 1 USD. There are no changes on the reimbursement reference list during the analyzed period.
RESULTS: RESULTS: A 2-year cost comparison of infliximab, Adalimumab, Etanercept, Rituximab, Trastuzumab and Bevacizumab biosimilars versus reference biologicals was performed. The total cost avoided in 24 months was USD 1,488,290.73 in 1131 patients/month. Savings per molecule in USD (and quantity of patients / month) was Infliximab USD 318,796.71 (242); Adalimumab USD 897,822.61 (745); Rituximab USD 33,100.98 (2); Etanercept USD 3,404.15 (3); Bevacizumab USD 37,080.80 (121); Trastuzumab USD 198,085.47 (239). The usage of Biosimilars increased from 39% to 80%.
CONCLUSIONS: CONCLUSION: The use of biosimilars in Brazil has been expanded, but entry and acceptance by both prescribers and healthcare providers is still challenging. There is a potential to increase access, relevant cost reduction and financial sustainability for a medium-sized insurance company in Brazil.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE297
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, STA: Biologics & Biosimilars