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)

BMC Health Services Research

Research

Espen AndreHaavardsholm¹  Pawel Mielnik²  Mari Hoff³  Bjørg Tilde Svanes Fevang⁴  Camilla Zettel⁵  Gunnstein Bakland⁶  Andreas P Diamantopoulos⁷  Lene Kristin Brekke⁸  Liz Loli⁹  Alen Brkic^1,10  Glenn Haugeberg^1,11 

[1] Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway;Institute of Clinical Medicine, University of Oslo, Oslo, Norway;Department for Neurology, Section for Rheumatology, Rheumatology and Physical Medicine,, District General Hospital of Førde, Førde, Norway;Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway;Department of Rheumatology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;Department of Rheumatology, Bergen Group of Epidemiology and Biomarkers in Rheumatic Disease, Haukeland University Hospital, Bergen, Norway;Department of Rheumatology, Betanien Hospital, Skien, Norway;Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway;Division of internal medicine, Section for Rheumatology, Akershus University Hospital, 1478, Lørenskog, Norway;Haugesund Hospital for Rheumatic Diseases, Haugesund, Norway;Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway;Research Department, Sorlandet Hospital, Service box 416, Kristiansand, Norway;Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway;Research Department, Sorlandet Hospital, Service box 416, Kristiansand, Norway;Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway;Division of Rheumatology, Department of Medicine, Sorlandet Hospital, Kristiansand, Norway;

关键词: Pharmaceutical tendering;    Biosimilars;    Biologics;    Subcutaneous;    Intravenous;   

DOI  :  10.1186/s12913-023-09975-7

 received in 2022-12-14, accepted in 2023-08-27,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundBiologic 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.MethodThe 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.ResultThe 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.ConclusionBased 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.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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