What are the cheapest Tumor Necrosis Factor (TNF) inhibitors?

Cheapest TNF Inhibitors

Biosimilars of TNF inhibitors are the cheapest options, with prices typically 20-40% lower than their bio-originators, and should be preferred when they are appreciably less expensive. 1

Cost Comparison of TNF Inhibitors

• Biosimilars of infliximab, adalimumab, and etanercept are widely available and offer significant cost savings compared to their bio-originators 1
• In the United States, etanercept has shown the lowest annual cost per treated patient ($17,767), followed by adalimumab ($19,272), and infliximab ($24,273) 2
• In European markets, the introduction of biosimilars has resulted in price reductions of the bio-originators, with the first biosimilars of infliximab and adalimumab decreasing prices by 13.6% and 0.9% respectively, while second biosimilars further reduced prices by 26.4% and 27.3% 3
• In countries with competitive tender processes like Norway, biosimilar infliximab has been priced up to 69% lower than the bio-originator 1

Factors Affecting TNF Inhibitor Pricing

• Market competition significantly impacts pricing - countries with greater biosimilar competition experience larger price reductions 1, 3
• The pricing strategy of bio-originators can limit biosimilar uptake, as seen with Humira (adalimumab) in some European countries 3
• First biosimilars to enter the market typically capture at least twice the market share of subsequent biosimilars for the same molecule 3
• Biosimilars in the US market have been priced only 15% lower than bio-originators at launch, which is less competitive than in European markets 1

Cost-Saving Strategies

• The European League Against Rheumatism (EULAR) states that biosimilars approved by regulatory authorities should be preferred if they are appreciably less expensive than the originator or other biological compounds 1
• Switching from bio-originators to biosimilars can generate significant savings for healthcare systems without compromising efficacy or safety 1
• Competitive tender processes, as implemented in some national hospital systems, can achieve the greatest price reductions (up to 69% lower) 1
• The introduction of TNF inhibitor biosimilars has generated market competition resulting in price reductions for their reference products and other bio-originator TNF inhibitors 1

Clinical Considerations

• Biosimilars approved by authorities in highly regulated areas have equivalent efficacy and comparable safety to their bio-originators 1
• All five TNF inhibitors (infliximab, adalimumab, etanercept, golimumab, and certolizumab pegol) are effective for rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis, but only infliximab, adalimumab, and golimumab are effective for inflammatory bowel disease 4
• Etanercept has not demonstrated efficacy in Crohn's disease and is not indicated for this condition 1
• The decision to switch from a bio-originator to its biosimilar should involve both the healthcare provider and the patient 1

Pitfalls and Caveats

• Small price differentials between biosimilars and bio-originators may decrease market penetration of biosimilars and reduce cost savings 1
• Biosimilar cost savings have not reached the 80% price reduction seen with generic small molecule drugs 1
• Some patients and healthcare providers incorrectly presume that biosimilars are of lesser quality due to their lower price 1
• Switching between multiple biosimilars or between a bio-originator and its biosimilar on multiple occasions raises concerns due to limited evidence 1
• Discounts and rebates provided to third-party payers by bio-originator manufacturers might reduce or eliminate the price differential between a biosimilar and its bio-originator 1