Exploring the impact of the national tender system on the use of costly drugs treating rheumatoid arthritis patients in ten rheumatology centers in Norway (2010-2019).

Abstract

BACKGROUND:

Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) are highly effective in treating rheumatoid arthritis (RA), albeit high drug cost has restricted their use in many countries. As a countermeasure, Norway implemented pharmaceutical tendering as a cost-reducing strategy. The aim of this study was to assess the annual proportion of different b/tsDMARDs registered to treat RA patients under the influence of a Norwegian pharmaceutical tendering between 2010 and 2019.

METHOD:

The data is collected from ten Norwegian outpatient centers. The included patients are categorized as naïve, non-naïve, and current b/tsDMARD users. 13 individual b/tsDMARDs are assessed and compared with the tender rankings from each year. Overview of subcutaneous (sc) with per oral vs. intravenous (iv) and biosimilars vs. non-biosimilar are also described.

RESULT:

The tender-winning b/tsDMARD was the most or second most used drug in nine out of ten years for naïve users, seven for non-naïve users, and twice for current users. The average sum of the highest and second highest proportion among naïve, non-naïve, and current b/tsDMARD users were 75%, 53%, and 50% during the ten years, respectively. The tender-winning drug was iv in eight out of ten years. However, the average total proportion of sc and per oral b/tsDMARDs was about 70% for naïve b/tsDMARD users, 50% for non-naïve b/tsDMARD users, and 60% for current b/tsDMARD users. The main contributors to sc and per oral b/tsDMARD were etanercept (reference and biosimilar) and certolizumab pegol. The main contributors to iv b/tsDMARD were rituximab reference and infliximab biosimilar. Despite low-ranking offers, rituximab reference (offered as a second-line drug) often achieved a high proportion among non-naïve and current b/tsDMARD users. After the introduction of biosimilars, their average proportion was about 40%, 40%, and 20% for naïve, non-naïve, and current b/tsDMARD users, respectively.

CONCLUSION:

Based on observed data, a higher tender rank was associated with a higher proportion among naïve and non-naïve b/tsDMARD users. However, in most cases, sc b/tsDMARDs achieved a higher proportion with lower tender ranks than iv b/tsDMARDs with higher tender ranks.

• Authors: Alen Brkic, Andreas P Diamantopoulos, Mari Hoff, Espen Andre Haavardsholm, Bjørg Tilde Svanes Fevang, Lene Kristin Brekke, Liz Loli, Camilla Zettel, Gunnstein Bakland, Pawel Mielnik, Glenn Haugeberg
• Journal: BMC health services research (BMC Health Serv Res) Vol. 23 Issue 1 Pg. 968 (Sep 07 2023) ISSN: 1472-6963 [Electronic] England
• PMID: 37679747 (Publication Type: Journal Article)
• Copyright: © 2023. BioMed Central Ltd., part of Springer Nature.

Chemical References

• Rituximab
• Biosimilar Pharmaceuticals
• Pharmaceutical Preparations

Topics

• Humans
• Rituximab
• Biosimilar Pharmaceuticals (therapeutic use)
• Rheumatology
• Arthritis, Rheumatoid (drug therapy)
• Outpatients
• Norway
• Pharmaceutical Preparations