Uptake of Biosimilars and Its Economic Implication for the Treatment of Patients with Rheumatoid Arthritis in Korea

Abstract

Background: We aimed to examine the uptake of infliximab and etanercept biosimilars in patients with rheumatoid arthritis (RA) and its economic implication for healthcare expenditure.

Methods: Using Korean Health Insurance Review and Assessment Service National Patient Samples, we extracted RA patients who used biologic disease modifying anti-rheumatic drugs (bDMARDs) between 2009 and 2018. Descriptive statistics were used to explain the basic features of the data. We calculated the proportion of users of each bDMARD among total patients with bDMARDs half-yearly. We assessed changes in the utilization proportions of bDMARDs including 4 tumor necrosis factor inhibitors (TNFis) and 2 non-TNFis, which have been approved for RA in Korea: etanercept, infliximab, adalimumab, golimumab, tocilizumab, and abatacept, and analyzed the changes in market share of biosimilars among the bDMARDs after their introduction. Overall trends of medical costs for each bDMARD were presented over the 10-year period.

Results: Since the introduction of the biosimilar TNFis in 2012, the proportion of their use among bDMARDs steadily increased to 15.8% in 2018. While there has been a gradual increase in the use of biosimilar TNFis, the use of the corresponding originators has been decreasing. The introduction of biosimilar TNFis has resulted in a decrease in the medical costs of patients using either originator or biosimilar TNFis.

Conclusion: In Korea, the proportional use of biosimilar TNFis has gradually increased since their introduction. The availability of less expensive biosimilar TNFis seems to have brought about a decrease in the medical costs of users of the originators.

Keywords: Arthritis, Rheumatoid; Biologics; Biosimilar; Trend.

Fig. 1. Utilization of TNFis and non-TNFis in rheumatoid arthritis patients between 2009 and 2018.

TNFi = tumor necrosis factor inhibitor.

Fig. 2. Longitudinal changes in the relative market share of (A) TNFis vs. non-TNFis and (B) individual bDMARDs between 2009 and 2018.

TNFi = tumor necrosis factor inhibitor, bDMARD = biologic disease modifying anti-rheumatic drug.

Fig. 3. Longitudinal changes in the relative market share of tumor necrosis factor inhibitor originators and biosimilars, (A) infliximab and (B) etanercept, between 2009 and 2018.

Fig. 4. Longitudinal changes in the per patient medical costs for users of (A) bDMARDs, (B) infliximab, and (C) etanercept between 2009 and 2018.

TNFi = tumor necrosis factor inhibitor, bDMARD = biologic disease modifying anti-rheumatic drug.