OBJECTIVES: To analyze the evolving landscape of anti-TNF biosimilars in Europe from 2018 to 2023 and examine its implications for market competition and sustainability.

METHODS: A comparative analysis across 24 European countries was conducted based on IQVIA MIDAS® sales data (licensed from IQVIA. Copyright IQVIA. All Rights Reserved). The 3 anti-TNFs adalimumab, etanercept and infliximab were included. Market sustainability was assessed in 3 dimensions: accessibility, affordability, and availability, using defined daily dose/capita (DDD/capita), biosimilar penetration and number of biosimilar competitors with market share above 3% as a proxy, respectively.

RESULTS: From 2018 to 2023, the number of countries with high accessibility (DDD/capita≥1) has doubled. Five countries moved from medium (0.5≤DDD/capita<1) to high accessibility with an average absolute increase of 0.43 DDD/capita. Among these 5 countries, Austria shows high accessibility, despite the low biosimilar penetration with an absolute increase of only 20%.

CONCLUSIONS: To guarantee a healthy level of competition and maximize the economic and patient benefits of having multiple affordable alternatives, it is crucial that payors, policy makers and procurement authorities work together to drive positive policy change and implement procurement and market policies balancing accessibility, affordability, and availability to ensure long-term sustainability.