Roth Joshua A, Kratochvil David, Dorman Stephanie, Bernauer Mark
Pfizer, New York, NY, USA.
School of Pharmacy, University of Washington, Seattle, WA, USA.
J Med Econ. 2025 Dec;28(1):378-386. doi: 10.1080/13696998.2025.2474884. Epub 2025 Mar 11.
Biosimilars to originator bevacizumab (Avastin), such as bevacizumab-bvzr (Zirabev), can deliver substantial savings and/or expanded access to biologic therapy for patients with metastatic colorectal (mCRC) and non-squamous non-small cell lung cancer (mNSCLC). The objective of this study is to explore the cost-efficiency and budget-neutral expanded access of bevacizumab-bvzr in mCRC and mNSCLC in Medicare.
We developed a Medicare payer perspective simulation model of patients treated for mCRC and mNSCLC to estimate cost-savings from converting bevacizumab (originator) to bevacizumab-bvzr or alternative biosimilars such as bevacizumab-awwb, -maly, and -abcd. The target patient population receiving annual first-line systemic therapy was calculated using Medicare enrollment data, SEER cancer incidence rates in patients age ≥65, and an assumption that 39.3% and 77.2% of new diagnoses receive systemic therapy for mCRC and mNSCLC respectively based on recent evidence. 76.0% of systemically treated mCRC patients and 11.4% of incident mNSCLC patients were expected to be treated with bevacizumab-based regimens based on recent evidence. Costs were derived from the 2024 Average Sales Price (ASP). Results include per-patient per-month (PPPM) cost savings (vs. originator), total monthly savings in the cohort, and number needed to convert (NNC) to biosimilar to fund the treatment of an additional 100 patients.
PPPM savings from conversion to bevacizumab-bvzr were $4,205 in mCRC and $8,410 in mNSCLC. In 100% conversion scenarios, full cohort monthly savings were $27,664,432 in mCRC ( = 6,579) and $32,319,323 in mNSCLC ( = 3,843), respectively. At 100% conversion, monthly savings from biosimilar conversion could fund up to 13,887 additional mCRC patient-months of treatment with bevacizumab-bvzr + FOLFOX, and up to 8,959 additional mNSCLC patient-months of treatment with bevacizumab-bvzr + paclitaxel + carboplatin. In mCRC and mNSCLC the biosimilar NNC from the originator was 47 and 43, respectively. The biosimilar NNC from other biosimilars ranged from 60-4,564 and 55-4,422 for mCRC and NSCLC, respectively.
In the first cost-efficiency and expanded access study of biosimilar bevacizumab in mCRC and mNSCLC, we find that bevacizumab-bvzr-based regimens can result in substantial cost savings relative to originator-based first line treatment in Medicare. These cost savings could be reinvested to treat a substantial number of additional patients with mCRC or mNSCLC, or fund other costs of care in Medicare, on a budget-neutral basis.
贝伐珠单抗（安维汀）的生物类似药，如贝伐珠单抗 - bvzr（齐拉贝），可为转移性结直肠癌（mCRC）和非鳞状非小细胞肺癌（mNSCLC）患者带来可观的成本节省和/或扩大生物治疗的可及性。本研究的目的是探讨贝伐珠单抗 - bvzr在医疗保险中治疗mCRC和mNSCLC的成本效益及预算中性的扩大可及性。
我们建立了一个从医疗保险支付方角度出发的针对mCRC和mNSCLC患者的模拟模型，以估算将贝伐珠单抗（原研药）转换为贝伐珠单抗 - bvzr或其他生物类似药（如贝伐珠单抗 - awwb、-maly和 - abcd）所节省的成本。使用医疗保险参保数据、年龄≥65岁患者的监测、流行病学和最终结果（SEER）癌症发病率，以及基于近期证据假设分别有39.3%和77.2%的mCRC和mNSCLC新诊断患者接受全身治疗，计算接受年度一线全身治疗的目标患者群体。根据近期证据，预计76.0%的接受全身治疗的mCRC患者和11.4%的新发mNSCLC患者将接受基于贝伐珠单抗的治疗方案。成本来自2024年平均销售价格（ASP）。结果包括每位患者每月（PPPM）的成本节省（与原研药相比）、队列中的每月总节省以及转换为生物类似药以资助额外100名患者治疗所需的转换数量（NNC）。
转换为贝伐珠单抗 - bvzr后，mCRC的PPPM节省为4205美元，mNSCLC为8410美元。在100%转换的情况下，mCRC队列每月的总节省为27,664,432美元（n = 6579），mNSCLC为32,319,323美元（n = 3843）。在100%转换时，生物类似药转换带来的每月节省可资助多达13,887个额外的mCRC患者 - 月的贝伐珠单抗 - bvzr + 氟尿嘧啶、亚叶酸钙、奥沙利铂（FOLFOX）治疗，以及多达8959个额外的mNSCLC患者 - 月的贝伐珠单抗 - bvzr + 紫杉醇 + 卡铂治疗。在mCRC和mNSCLC中，从原研药转换为生物类似药的NNC分别为47和43。对于mCRC和NSCLC，从其他生物类似药转换的NNC分别为60 - 4564和55 - 4422。
在第一项关于生物类似药贝伐珠单抗在mCRC和mNSCLC中的成本效益及扩大可及性的研究中，我们发现基于贝伐珠单抗 - bvzr的治疗方案相对于医疗保险中原研药一线治疗可节省大量成本。这些成本节省可重新投资，以在预算中性的基础上治疗大量额外的mCRC或mNSCLC患者，或资助医疗保险中的其他护理费用。
