OBJECTIVES : To save costs to the health care system, forced non-medical switch (NMS) policies that cut drug coverage for originator biologics and fund only less expensive biosimilars are being implemented. However, costs related to the impact of NMS on health care resource utilization (HCRU) must also be considered. This study aims to summarize the evidence on the true economic impact of an originator-to-biosimilar NMS.

METHODS : A systematic literature review (SLR) was conducted. Publications reporting on HCRU or costs associated with originator-to-biosimilar NMS in the real-world setting were searched in MEDLINE and EMBASE from January 2008 to February 2020. In addition to hand searching the reference lists of relevant publications and SLRs, key conference websites, PubMed and various government sites were also searched for the two years preceding the search (2018-2020).

RESULTS : A total of 1,845 citations were identified, of which 49 were retained for data extraction. Most studies reporting on the HCRU associated with NMS reported on post-NMS HCRU alone without a comparison pre-NMS. However, all 4 studies that described a difference in HCRU reported an increase in resources, including laboratory testing, imaging, medical visits, and hospitalizations, amongst patients who underwent an originator-to-biosimilar NMS. Most studies reporting on the costs associated with NMS reported a significant savings following NMS based on drug costs alone. However, all 4 studies specifically reporting on the difference of costs found that, when both HCRU-related costs and drug costs are considered, the overall savings associated with originator-to-biosimilar NMS were greatly reduced and, at times, resulted in an increase, rather than decrease, in annual costs per patient.

CONCLUSIONS : Amongst the studies that reported on the difference in HCRU, all showed an increase in HCRU and related costs associated with NMS. Nevertheless, more real-world studies that include NMS-related healthcare costs in addition to drug costs are needed.