为了节省医疗保健系统的成本,正在实施强制非医疗转换(NMS)政策,这些政策削减了原始生物制剂的药物覆盖范围,并仅为较便宜的生物仿制药提供资金。然而,还必须考虑与NMS对医疗保健资源利用(HCRU)的影响相关的成本。本研究旨在总结鼻祖对生物仿制药NMS的经济影响的证据。
进行了系统文献综述(SLR)。2008年1月至2020年2月,在MEDLINE和EMBASE中搜索了报告HCRU或与真实世界环境中的鼻祖到生物仿制药NMS相关成本的出版物。除了手动搜索相关出版物和SLR的参考列表外,主要会议网站,PubMed,在搜索之前的2年内(2018-2020年),还搜索了各种政府网站。
总共确定了1845篇引文,其中49人被保留用于数据提取。大多数报告与NMS相关的HCRU的研究仅报告了NMS后的HCRU,而没有比较NMS前的HCRU。然而,四项研究描述了HCCU的差异(即,切换前与切换后或非切换者与切换者之间的调查),所有这些都报告了HCCU的相对增加,包括实验室测试,成像,医疗访问,和住院,在接受了鼻祖-生物相似物NMS的患者中。大多数报告与NMS相关成本的研究报告说,仅基于药物成本,在NMS之后就节省了大量资金。然而,四项研究特别报告了发起人到生物类似品NMS后的成本差异,所有研究均表明与NMS相关的HCRU相关成本增加(HCRU相关成本增加4-37%或148-22342020加元)。
在报告HCRU切换前与切换后或非切换者与切换者之间差异的研究中,所有这些都显示了与NMS相关的HCCU和相关成本的增加,这表明,由于HCCU及其相关成本的增加,转换后成本较低的药品价格可能会减少预期的总体节省。然而,需要更多现实世界的研究,包括NMS相关的医疗保健成本,除了药物成本。
To save costs to the healthcare 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 healthcare resource utilization (HCRU) must also be considered. This study aims to summarize the evidence on the economic impact of an originator-to-biosimilar NMS.
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 2 years preceding the search (2018-2020).
A total of 1845 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, four studies described a difference in HCRU (i.e., investigations pre- vs post-switch or between non-switchers vs switchers), all of which reported a relative increase in HCRU, 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 significant savings following NMS on the basis of drug costs alone. However, four studies specifically reporting on the difference of costs following originator-to-biosimilar NMS all demonstrated an increase in HCRU-related costs associated with NMS (increase in HCRU-related costs of 4-37% or 148-2234 2020 Canadian dollars).
Amongst the studies that reported on the difference in HCRU pre- vs post-switch or between non-switchers and switchers, all showed an increase in HCRU and related costs associated with NMS, suggesting that the expected overall savings due to less costly drug prices may be reduced as a result of an increase in HCRU and its associated costs post-switch. Nevertheless, more real-world studies that include NMS-related healthcare costs in addition to drug costs are needed.