Artikel
Comparison of Remsima® and Remicade® – A Cost-Effectiveness Analysis for the German SHI System
Suche in Medline nach
Autoren
Veröffentlicht: | 4. September 2017 |
---|
Gliederung
Text
Background: In 2013, the first lower-priced Infliximab (IFX) biosimilars Remsima® and Inflectra® were approved in the EU. As a result, German statutory health insurance (SHI) expenditure for Remicade® Infliximab (IFX) decreased by 4,3 % in 2015. Still being one of the bestselling drugs, Remicade® led to net expenditure of 228,1 Mio € for the SHI system in 2015. Despite its economic relevance, the cost-effectiveness of biosimilars has not been analyzed for the German SHI system.
We aim to implement a method to examine the cost-effectiveness of biosimilars for patients with ankylosing spondylitis (AS) in Germany. For Remsima® we analyze the cost-effectiveness and compare it to Remicade® IFX.
Methods: We simulate 10 000 hypothetical AS-patients by setting up an individual patient sampling lifetime model. Initial characteristics are derived from clinical studies, direct and indirect costs are incorporated. After each 6-month-cycle, treatment might be discontinued due to loss of efficacy or adverse events. The patients BASFI is recorded and converted to quality of life. Incremental quality-adjusted life years (QALYs) are calculated.
Results: Excluding VAT and mandatory rebate, direct costs are 82.406,24 € for Remsima® vs. 95.799,21 € for Remicade®. Indirect costs are 441.301,00 € vs. 439.620,30 €. Total costs including VAT and mandatory rebate are 540.338,08 € vs. 555.044,64 and 523.707,23 € vs. 535.419,52 € excluding VAT and mandatory rebate. Patients gain 5,09 QALYs with Remsima® and 4,86 QALYs with Remicade®. The incremental cost-utility ratio is negative for the biosimilar, i.e. patients gain more QALYs with lower total costs. Sensitivity analysis shows the results' robustness, when altering overall time on treatment, time on treatment with NSAR, mortality, and disease progression.
Conclusion: The analysis with our complex probabilistic model shows that estimation of cost-effectiveness relies on simulation of a lifetime horizon to capture the whole range of the treatments’ economic effects. Compared to Remicade®, the therapy with Remsima® is more cost-effective and lowers overall costs from a societal perspective.