Cost savings from the use of biosimilars in Canada

Analysis of the potential cost savings from the use of three biosimilars (filgrastim, infliximab and insulin glargine) in Canada shows that over CA$1 billion could have been saved in just a two-year period [1].

The first biologicals became available in Canada in 1983, with the introduction of recombinant deoxyribonucleic acid (rDNA) insulin. Today there are dozens of biologicals available in Canada, which in 2017 represented seven of the top 10 selling patented medications in the country. Spending on biologicals has been similarly high – overall spending on biologicals reached CA$3.6 billion in 2016 (almost 16% of pharmaceutical sales for the entire country), placing a significant burden on the healthcare system.

Biosimilars, more affordable versions of originator biologicals, are an important means of reducing costs to the healthcare system. Canada has, in many ways, been a pioneer of biosimilar use. In May 2019, the province of British Columbia stopped coverage of originator biologicals and switched patients to biosimilars for a range of indications [2], followed soon after by Alberta and Ontario [3].

A team of researchers from the University of Saskatchewan assessed the cost savings from the use of biosimilars in Canada in a study published [1],

They focused on three commonly prescribed biologicals: filgrastim (a treatment for low neutrophil count, such as occurs in HIV/AIDS or following chemotherapy), infliximab (a tumour necrosis factor-alpha [TNF-α] inhibitor for a range of auto-immune diseases including inflammatory bowel disease and arthritis), and insulin glargine (a long-acting form of insulin used to treat diabetes). Biosimilars of these products (named Grastofil, Inflectra and Basaglar, respectively) were approved in Canada in 2014‒2015 [4].

To estimate the potential cost savings from the use of these biosimilars, the researchers performed a retrospective analysis of purchases in Canada from 2016‒2018.

They used data on purchases from drugstores and hospitals to estimate the costs per unit and unit volume for biosimilars and originators within each province. Potential cost savings were calculated as a product of the units of reference originator purchased and the cost difference between the originator and its corresponding biosimilar.

The researchers found that, if the use of biosimilars was 100%, over CA$1 billion could have been saved during the two-year period. However, only 4.2% of this potential (CA$46 million) was actually saved.

Because individual provinces are responsible for their own spending on health care, there were substantial regional differences in biosimilars’ use. The highest percentage of biosimilars’ use occurred in Saskatchewan in Western Canada, where 81.6% of all filgrastim purchased was the biosimilar version (Grastofil). Some provinces however purchased biosimilar filgrastim less than 1% of the time.

The highest potential savings (CA$349 million) could be made in Ontario, but even in smaller markets such as Newfoundland, CA$28 million could have been saved, say the authors.

Commenting on the mismatch between the potential and realized savings, the authors say uptake of biosimilars in Canada has been slow and overall use of biosimilars in the country is low. Reasons for this include the complexity of biosimilars, low rates of discounting and a lack of patient awareness.

This can be contrasted with high uptake rates seen in some parts of Europe [5]. In Norway for example, biosimilar infliximab now has more than 90% of the market share. Factors responsible for this higher uptake could be lower prices, competition through tendering, and recommendations from opinion leaders. In Norway, probably the most influential factor was the fact that biosimilar infliximab was offered to the country’s price regulator at a discount of 72% [6].

To increase biosimilar use and realize major cost savings in Canada, the researchers recommend urgent discussions by key stakeholders and new policies to prioritize the use of biosimilars.

Conflict of interest
The authors of the research paper [1] declared that there was no conflict of interest. They did, however, acknowledge receipt of a grant from Canadian pharmaceutical company Apobiologix for the study.

Editor’s comment
Readers interested to learn more about the biosimilars market in Canada are invited to visit www.gabi-journal.net to view the following manuscripts published in GaBI Journal:

An ever-evolving landscape: an update on the rapidly changing regulation and reimbursement of biosimilars in Canada

Ever-changing landscape of biosimilars in Canada; findings and implications from a global perspective

Readers interested in contributing a research or perspective paper to GaBI Journal – an independent, peer reviewed academic journal – please send us your submission here.

Brand-name discount cards increase private insurance spending in Canada

References
1. Mansell K, Bhimji H, Eurich D, et al. Potential cost-savings from the use of the biosimilars filgrastim, infliximab and insulin glargine in Canada: a retrospective analysis. BMC Health Serv Res. 2019;19(1).
2. GaBI Online - Generics and Biosimilars Initiative. Canada’s British Columbia to switch patients to biosimilars [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Mar 27]. Available from: www.gabionline.net/Policies-Legislation/Canada-s-British-Columbia-to-switch-patients-to-biosimilars
3. GaBI Online - Generics and Biosimilars Initiative. Ontario becomes third Canadian province to switch patients to biosimilars [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Mar 27]. Available from: www.gabionline.net/Biosimilars/General/Ontario-becomes-third-Canadian-province-to-switch-patients-to-biosimilars
4. GaBI Online - Generics and Biosimilars Initiative. Biosimilars approved in Canada [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Mar 27]. Available from: www.gabionline.net/Biosimilars/General/Biosimilars-approved-in-Canada
5. GaBI Online - Generics and Biosimilars Initiative. Use of biosimilars in Europe differs across countries [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Mar 27]. Available from: www.gabionline.net/Reports/Use-of-biosimilars-in-Europe-differs-across-countries
6. GaBI Online - Generics and Biosimilars Initiative. Huge discount on biosimilar infliximab in Norway [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2020 Mar 27]. Available from: www.gabionline.net/Biosimilars/General/Huge-discount-on-biosimilar-infliximab-in-Norway

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