Direct healthcare costs of chronic kidney disease management in Italy: What cost‐savings can be achieved with higher biosimilar uptake and more appropriate use of erythropoiesis‐stimulating agents?

Abstract

Purpose Erythropoiesis‐stimulating agents (ESAs), are used for treating chronic kidney disease (CKD)‐related anemia, contributing to CKD costs. The study was aimed at investigating direct healthcare costs of CKD patients treated with ESAs and the potential savings achievable by increasing the use of biosimilars and preventing inappropriate ESA use. Methods A multi‐center, cohort study was conducted using claims databases of five large Italian geographic areas. Yearly mean direct healthcare costs per patient were estimated, stratifying by CKD stage. The total yearly cost and potential savings related to ESA use were estimated: (a) considering 25/50/75% of originator ESA substitution with biosimilars; (b) eliminating inappropriate ESA dispensing. Results During the study period, the ESA‐related yearly mean cost represented 17% of total yearly costs in stage I‐III, decreasing to 13% in stage IV‐V and 6% in dialysis. Among originator users, assuming a 25% of biosimilar uptake, the annual cost‐savings of ESA treatment would represent 10.5% of total ESA costs in CKD stage I‐V and 7.7% in dialysis. Among incident ESA users for which hemoglobin levels were available, 9% started inappropriately ESA treatment, increasing to 62.0% during the first year of maintenance therapy. Hypothesizing prevention of the first inappropriate ESA dispensing, the total yearly cost‐savings would amount to €35 772, increasing to €167 641 eliminating the inappropriate dispensing during maintenance therapy. Conclusions Higher use of lowest cost ESA, prevention of inappropriate ESA use as well as other strategies aimed at slowing down the progressive renal impairment are essential for minimizing clinical and economic burden of CKD.

Modeling Chronic Kidney Disease in Type 2 Diabetes Mellitus: A Systematic Literature Review of Models, Data Sources, and Derivation Cohorts

“…For example, among commercially insured US patients with CKD, microalbuminuria, and T2DM, per-person per-year costs were USD 18,529 in patients with CKD stage 1, compared with USD 110,210 in patients with CKD stage 5 [4]. Similar findings were reported for Germany, where mean per-person annual costs for were EUR 8030 for patients in CKD stage 3 relative to EUR 44,374 for dialysis-treated patients [9], and for Italy, where mean direct healthcare costs per patient in the first year of treatment with erythropoiesis-stimulating agents were EUR 8917 for patients in CKD stages 1-3 compared with EUR 31,985 for dialysis-treated patients [10]. In China, the mean annual costs for hemodialysis and peritoneal dialysis were Chinese yuan (CNY) 94,761 and CNY 80,763 per patient, compared with CNY 132,253 and CNY 93,155 per patient with a kidney transplant in the first and second year, respectively [11].…”

Off-Patent Biological and Biosimilar Medicines in Belgium: A Market Landscape Analysis

“…Competing product classes, like JAK inhibitors, will expand their indication profiles in the coming years, with newly approved indications and new products entering the market (Ferrante and Sabino, 2019;Westhovens, 2019). Notwithstanding the importance to stimulate the usage of bestvalue biologicals to support a sustainable healthcare system, policymakers should also pay attention to the incorrect or unnecessary usage of expensive biological therapies (Westhovens and Annemans, 2016;Ingrasciotta et al, 2021). Stimulating a competitive market is an important, yet not the only strategy to safeguard a sustainable healthcare system.…”