Cost-Substitution and Hospital Diagnosis-Related Group (DRG) Performance Impact Analysis of Infliximab Biosimilar Adoption in Moderate-to-Severe Crohn's Disease Patients in China
Author(s)
Shuting Chen, MS1, Yongjia Zhuo, MS1, Yue Gao, MPH1, Jianfang Jiang, MD2, Jianwei Xuan, PhD1, Qian Cao, MD2.
1Health Economics Research Institute, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China, 2Sir Run Run Shaw Hospital, Hangzhou, China.
1Health Economics Research Institute, School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China, 2Sir Run Run Shaw Hospital, Hangzhou, China.
OBJECTIVES: To evaluate the budget impact on China's healthcare insurance fund and hospital case-level financial performance under Diagnosis-Related Group (DRG) policy in Hangzhou, resulting from substituting Infliximab originator (Remicade®, Janssen Biologics B.V.) with its biosimilar (Anbaite®, BioRay Pharmaceutical Co., Ltd.) for treating moderate-to-severe Crohn's Disease (CD).
METHODS: A cost-substitution budget impact analysis model over 2025-2027 from a health insurance payer perspective was conducted by using real-world data from Sir Run Run Shaw Hospital—a major tertiary referral center for CD cases in Zhejiang province—to derive clinical practice patterns and cost parameters. Epidemiological inputs were sourced from the 2023 Provincial Bulletin and published literature, while DRG payment standards for CD were obtained from the Hangzhou Medical Security Bureau. Biosimilar adoption rates were projected based on manufacturer forecasts. Deterministic sensitivity analysis assessed the robustness of key model drivers.
RESULTS: Without infliximab biosimilar in National Drug Reimbursement List (NRDL), infliximab's annual direct medical cost for treating Crohn's disease is ¥46.87 million, with ¥32.8 million covered by the insurance fund. With inclusion, costs decrease to ¥45.73 million, ¥45.71 million, and ¥44.6 million for 2025-2027, reducing insurance fund expenditure to ¥32 million, ¥31.61 million, and ¥31.21 million respectively, yielding cumulative savings of ¥3.573 million. Crucially, biosimilar's flexible pricing avoided low-payment deficits by actively optimizing DRG cost margins, reversing per-case hospital performance losses (-¥1,263) to surplus (+¥985). Sensitivity analysis identified the top influencing factors: the price of infliximab (the original product and the biosimilar) and the total Crohn's disease patients treated with the target medication in the hospital that year.
CONCLUSIONS: Under the Diagnosis Related Group (DRG) policy in Hangzhou, China, replacing infliximab with the biosimilar leads to savings in medical insurance fund and surplus of hospital departments performance.
METHODS: A cost-substitution budget impact analysis model over 2025-2027 from a health insurance payer perspective was conducted by using real-world data from Sir Run Run Shaw Hospital—a major tertiary referral center for CD cases in Zhejiang province—to derive clinical practice patterns and cost parameters. Epidemiological inputs were sourced from the 2023 Provincial Bulletin and published literature, while DRG payment standards for CD were obtained from the Hangzhou Medical Security Bureau. Biosimilar adoption rates were projected based on manufacturer forecasts. Deterministic sensitivity analysis assessed the robustness of key model drivers.
RESULTS: Without infliximab biosimilar in National Drug Reimbursement List (NRDL), infliximab's annual direct medical cost for treating Crohn's disease is ¥46.87 million, with ¥32.8 million covered by the insurance fund. With inclusion, costs decrease to ¥45.73 million, ¥45.71 million, and ¥44.6 million for 2025-2027, reducing insurance fund expenditure to ¥32 million, ¥31.61 million, and ¥31.21 million respectively, yielding cumulative savings of ¥3.573 million. Crucially, biosimilar's flexible pricing avoided low-payment deficits by actively optimizing DRG cost margins, reversing per-case hospital performance losses (-¥1,263) to surplus (+¥985). Sensitivity analysis identified the top influencing factors: the price of infliximab (the original product and the biosimilar) and the total Crohn's disease patients treated with the target medication in the hospital that year.
CONCLUSIONS: Under the Diagnosis Related Group (DRG) policy in Hangzhou, China, replacing infliximab with the biosimilar leads to savings in medical insurance fund and surplus of hospital departments performance.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE294
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
Biologics & Biosimilars, Gastrointestinal Disorders