A budget impact model for biosimilar denosumab for skeletal-related events and fractures in the United States oncology population.

BACKGROUND: The significant costs associated with cancer and related treatments are concerning for patients, providers, and payers. Denosumab is indicated to treat a variety of skeletal-related events (SREs) and fractures in cancer patients but remains costly. Biosimilars offer an affordable treatment option, which can potentially reduce healthcare costs and expand access to biological therapy. OBJECTIVE: Evaluate the budget impact of incorporating biosimilar denosumab into a health plan formulary for the oncology indications of reference denosumab products and estimate costs associated with SREs and fractures after reinvesting savings from biosimilar conversion. METHODS: Two models were developed to estimate the budget impact of biosimilar denosumab from a United States payer perspective over a 5-year period. The first model focused on total cost savings associated with switching to biosimilar denosumab from reference denosumab. In the second model, savings estimated in the first model were reinvested for conversion from zoledronic acid to biosimilar denosumab. RESULTS: The introduction of biosimilar denosumab resulted in total cost savings of $38,677,606 or $0.59 per member per month at year 5 in the base case. Cost savings were also seen with high and low scenarios as well as when the average sales price varied from 5% to 85%. Approximately 100 additional patients could be treated with biosimilar denosumab and an additional three SREs and fractures could be prevented with each 10% increase in reinvestment. LIMITATIONS: As the price of biosimilar denosumab was based on prior experiences of biosimilar prices relative to reference prices, current prices or payment limits of biosimilar denosumab may not be reflected. CONCLUSIONS: The availability of denosumab biosimilars provides an opportunity for oncology practices to assess the cost-effectiveness of biosimilar denosumab and expand access to biologicals to more patients.

Duke Scholars

Author Gary Herbert Lyman Medicine, Medical Oncology