Saving Costs While Maintaining Quality of Care—The Value of Biosimilars in Oncology

Can biosimilar products actually produce the cost savings to the healthcare system that they have promised? According to a review published in Cancer Management and Research, they can.

Although increased screening and better treatment options have improved outcomes, they have also resulted in growth in the number of patients who receive oncology and supportive care oncology products, ultimately resulting in higher healthcare costs. Cost of care is 1 of 3 factors influencing patient access to biologics, the remaining factors being insurance coverage and availability, and biosimilars are being developed as an important option that is expected to impact both access and cost.

Co-authored by Kashyap Patel, MD, from Carolina Blood and Cancer Care, and researchers from Pfizer, the review evaluated the cost of biologics used for cancer treatment as well as for supportive care, including for replenishing blood cells to balance the adverse effects associated with chemotherapy treatment. The authors explain that supportive treatment with granulocyte colony-stimulating factors, such as filgrastim and pegfilgrastim, improves patient response to treatment in addition to improving their health-related quality of life.

But the overall spend on cancer care has seen a significant upward trajectory—from $27 billion to $120 billion—during the 20 years between 1990 and 2010. By 2020, research estimates this spend to reach $157 billion, the authors write, with cost attributed to innovations in technology, hospitalization costs, and an increase in malignancy associated with a larger aging population with a longer life span.

Providing the example of biologic use in the cancer space among European nations, the authors explain that widespread adoption of biosimilars for supportive oncology care has not only improved access to treatment, but it has also rendered cost-saving opportunities for healthcare overall. The authors cite an IMS report that found substantial price reductions in epoetins following introduction of biosimilar competition: 25% to 29% in Scandinavia, 39% in France, and 55% in Germany. Prices of biologic and biosimilar filgrastim, meanwhile, saw a 14% dip in France and 27% in Germany following access to biosimilar competition in those countries.

Biosimilar market entry in the United States lagged nearly a decade behind the European market. Early studies have, however, proven cost savings associated with using the first biosimilar approved in the United States, filgrastim-sndz, the authors write. They present data showing that the payment limit from CMS for filgrastim-sndz was 28% lower than for the reference product in the fourth quarter of 2017, whereas for tbo-filgrastim, which is an alternate for filgrastim, it was 36% lower than for the reference.

With 13 biosimilar products now approved in the United States, this class of products can improve access and also reduce overall pharmaceutical expenditures, the authors write. Several pilot programs are currently being tested by CMS as healthcare transitions to adopting value-based care. The Medicare Shared Savings Program (MSSP) and the Oncology Care Model (OCM), for example, were developed to deliver more effective and efficient care with the caveat of being 2-sided risk programs, meaning both the provider and the payer have an equal share of the profits or they divide the burden if spending crosses the benchmark.

The authors point out that biosimilars offer a benefit under OCM, including affordability and improved outcomes and health-related quality of life. While an increased use of biosimilars could result in overall cost savings, the authors point to the need for increased education among providers to fill persistent knowledge gaps about biosimilars and their potential use in the clinic.

These include:

• Defining biologics versus biosimilars in the context of biosimilarity
• Understanding the approval process and the use of the “totality of evidence” approach by the US FDA for biosimilar evaluation
• Understanding the evidence requirements for demonstration of safety and immunogenicity of a biosimilar versus its reference product
• Understanding the rationale for indication extrapolation
• Defining interchangeability in the context of pharmacy-level substitution

“Biosimilars may provide an additional tool for providers participating in value-based care initiatives such as the MSSP and OCM, resulting in cost savings and efficiencies in the delivery of high-value care through expanded use of biologic treatment and supportive care agents during episodes of care,” the authors conclude.

Reference

Patel KB, Arantes LH, Tang WY, Fung S. The role of biosimilars in value-based oncology care. Cancer Manag Res. 2018;10:4591-4602. doi: 10.2147/CMAR.S164201.