Infliximab biosimilars 'more rapidly incorporated' in VA vs. academic centers
Uptake of infliximab biosimilars has been slow throughout the University of Pennsylvania Health System compared with the nearby Philadelphia Veterans Affairs Medical Center, which has realized savings from their use, according to findings published in Arthritis & Rheumatology.
“The main observation made by this study was that the VA system has much more rapidly incorporated the use of biosimilar therapies in practice,” Joshua F. Baker, MD, MSCE, of the University of Pennsylvania and the Philadelphia VA Medical Center, told Healio Rheumatology. “Biosimilars have the potential to significantly reduce costs to the health care system by introducing price competition between therapies.”
He added, “The observation that there are differences between the VA and the academic center is important because it suggests that differences in the health care systems have an important impact on the uptake of these new therapies and, therefore, an important impact on costs to each system.”
To compare biosimilar uptake at a VA medical center to that of an academic center — two environments with different institutional incentives for infused medications — Baker and colleagues conducted a cross-sectional study of medical data and financial policies at the University of Pennsylvania and the Philadelphia VA Medical Center. The researchers principally focused on three medications — infliximab (Remicade, Janssen), filgrastim (Neupogen, Amgen) and pegfilgrastim (Neulasta, Amgen) — and their biosimilars, prescribed between Jan. 1, 2015, and May 31, 2019.
All ordering events for filgrastim or infliximab products were quantified over time, stratified by product and center. The researchers analyzed financial incentives present at the institutions over time, determined based on actual drug costs for the VA Medical Center, as well as average sales prices and Medicare Part B reimbursement rates for the University of Pennsylvania.
The investigators reported there were 15,761 infusions of infliximab, 99% of which were for the reference product. However, there was a sharper decline in the use of reference products at the VA Medical Center, where 62% of the 446 infliximab infusions ordered were for the reference product. Average sales prices were consistently lower for the infliximab biosimilars, compared with the reference product, but the estimated financial incentives remained similar over time for both biosimilar and reference infliximab at the University of Pennsylvania.
The cost for 100 mg vials of reference infliximab and infliximababda at the VA Medical Center were $623.48 and $115.58, respectively — a $507.90, or 81%, savings per vial for the biosimilar.
“These observations primarily have significance for health care policy,” Baker said. “Since biosimilars are an important way to lower health care costs, it is important that we find ways to encourage their use. This study suggests that the current reimbursement policy does not favor their rapid incorporation in practice, which could slow their impact on costs in the long run. Also, it suggests we need to do more to educate and inform practitioners so that they feel more comfortable using these therapies, particularly if we are unable to provide other financial incentives for their use.” – by Jason Laday
Disclosures: Baker reports support through a U.S. Veterans Affairs Merit Award.