Doctors commitment and long-term effectiveness for cost containment policies: lesson learned from biosimilar drugs

Figures & data

Table 1 Biosimilar drugs marketed in Italy

Drugs	Originator	Biosimilar	Date of biosimilar marketing in Italy (AIFA)
Epoetin alfa	Eprex/erypro^®	Abseamed^®	April 2009
	Eprex/erypro	Binocrit^®	October 2008
Epoetin zeta	Eprex/erypro	Retacrit^®	February 2009
Filgrastim	Neupogen^®	Ratiograstim^®	April 2009
	Neupogen	Tevagrastim^®	May 2010
	Neupogen	Zarzio^®	January 2010
	Neupogen	Nivegrastim^®	June 2010
Somatropin	Genotropin^®	Omnitrope^®	April 2008

Abbreviation: AIFA, Italian Medicines Agency.

Table 2 Consumption rates for biosimilar drugs in the Campania region vs Italy, from 2009 to 2013

Biosimilar drugs	Counting units (%)					CAGR
	2009	2010	2011	2012	2013
Campania region	3,948 (1.6)*	64,703 (20.6)*	125,860 (35.5)*	158,056 (40.1)*	150,750 (35.9)*	107.2
Italy	67,998 (2.3)*	188,126 (5.7)*	410,397 (11.9)*	698,601 (19.7)*	930,859 (25.3)*	68.8

Note:

* Percentage of biological drugs consumed.

Abbreviation: CAGR, compound annual growth rate.

Table 3 Expenditure in Euro (€) on biosimilar drugs, 2009–2013, in the Campania region vs Italy

Biosimilar drugs	€ in millions (%)					CAGR
	2009	2010	2011	2012	2013
Campania region	0.258 (0.9)*	6,498 (18.3)*	12,099 (30.5)*	15,448 (35.3)*	15,281 (31.4)*	126.2
Italy	4,241 (1.4)*	14,837 (4.3)*	37,560 (10.4)*	67,498 (18.0)*	92,423 (23.9)*	85.2

Note:

* Percentage of biological drugs consumed.

Abbreviation: CAGR, compound annual growth rate.

Table 4 Pharmaceutical cost containment policies developed in the Campania region to incentivize the use of biosimilars

Measure	Date	Contents
Decree number 15^Citation18	November 30, 2009	All prescribers when prescribing biological treatments must prefer biosimilars with equal therapeutic indications and administration regimen, with an average savings target of at least 40% per therapy
Decree number 44^Citation19	July 14, 2010	Reiterates what was stated in decree number 15 and specifies that the obligation of prescribing biosimilar drugs for the same therapeutic indications refers to “naïve patients”
Decree number 34^Citation20	March 20, 2012	Reiterates what was stated in decree number 15 and specifies that in the treatment of naïve patients, the biosimilar drug with the lowest cost should be preferred
Decree number 27^Citation21	March 15, 2013	The biosimilar drug with the lowest cost per therapy should be considered as the first treatment option in naïve patients for all the therapeutic indications unless in case of negative clinician’s judgment

Note: Data modified from references.^18–21

Figure 1 Consumption of epoetin from 2009 to 2013 in the Campania region (A), and in Italy (B).

Note: Data modified from references.^18–21

Table S1 Expenditure in Euro (€) on biosimilar drugs and biological drugs, 2009–2013, Italy

Italy	€ in millions (%)
	2009	2010	2011	2012	2013
Biosimilar drugs	4,241 (1.4)*	14,837 (4.3)*	37,560 (10.4)*	67,498 (18.0)*	92,423 (23.9)*
Biological drugs	302,573	332,151	336,959	327,456	323,915

Note:

* Percentage of biological drugs consumed.

Table S2 Expenditure in Euro (€) on biosimilar drugs and biological drugs, 2009–2013, Campania region

Campania region	€ in millions (%)
	2009	2010	2011	2012	2013
Biosimilar drugs	0.258 (0.9)*	6,498 (18.3)*	12,099 (30.5)*	15,448 (35.3)*	15,281 (31.4)*
Biological drugs	27,053	34,846	38,118	41,944	45,576

Note:

* Percentage of biological drugs consumed.

Decreto n. 15 del 30 novembre 2009. [Decree number 15, November 30, 2009] Available from: http://www.aslna3sud.it/regione/DECRETO_15_DELIBERAZIONI_DEL_COMMISSARIO_AD_ACTAAccessed May 13, 2015 Italian

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Decreto commisariale n. 44 del 14/07/2010. [Decree number 44, July 14, 2010] Available from: http://www.aslcaserta.it/portale/Portals/0/doc_pub/2012/ATTIREGIONE/dca_44_Misure%20di%20controllo%20spesa%20farmaceutica.pdfAccessed May 13, 2015 Italian

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Decreto n. 34 del 20.03.2012. [Decree number 34, March 20, 2012] Available from: http://www.aslcaserta.it/portale/Portals/0/doc_pub/2012/ATTIREGIONE/34_Farmaci%20biosimilari.pdfAccessed May 13, 2015 Italian

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Decreto n. 27 del 15.03.2013. [Decree number 27, March 15, 2012] Available from: http://www.arsan.campania.it/documents/10157/59773/DCA_27_13.pdfAccessed May 13, 2015 Italian

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