ABSTRACT
BACKGROUND:
Healthcare sustainability is a global challenge. Various value-driven
healthcare strategies have been implemented by
Singapore's national
health technology assessment (HTA) agency, the Agency for Care
Effectiveness (ACE). Considering the high and growing
expenditure on
biologics,
strategies have been implemented to
drive the use of
biosimilars. As
Singapore has reached the 5-year mark since the subsidy listing of the first
monoclonal antibody biosimilar infliximab, this
review aimed to evaluate the impact of these
strategies on the changes in
adoption rates, utilisation, spending and
cost savings for
biosimilars in the public
healthcare sector.
METHODS:
A retrospective
cross-sectional study was conducted using aggregated
drug utilisation data from all public
healthcare institutions. Five
monoclonal antibodies with
biosimilars, namely
infliximab,
adalimumab,
trastuzumab,
rituximab and
bevacizumab, were included in this study. The outcomes evaluated were the monthly
trends for utilisation volume, proportion attributed to
biosimilar use, and
drug spending up to December 2022. The simulated
cost savings associated with
biosimilar adoption were also reported.
RESULTS:
After subsidy implementation, an upward trend in
biosimilar use and proportion attributed to
biosimilar adoption was observed, while spending reduced substantially. The
adoption rate of most
biosimilars reached more than 95% within 1 year of listing.
Drugs with more than one approved
biosimilar brand at the
time of subsidy listing reported substantial
price reductions of over 80%. Overall, spending for the five
monoclonal antibodies have significantly reduced after
biosimilar subsidy listing, with an estimated cumulative
cost savings of $136 million over 5 years.
CONCLUSION:
Value-driven
healthcare strategies implemented in
Singapore's public
healthcare institutions have contributed to high
adoption rates of
biosimilars and have improved affordable access through lower
treatment costs. This in turn has led to significant
cost savings to the healthcare system.