A cost-effectiveness modeling evaluation comparing a biosimilar follitropin alfa preparation with its reference product for live birth outcome in Germany, Italy and Spain

Gizzo, S, Ferrando, M, Lispi, M, Ripellino, C, Cataldo, N, Buhler, K,
J Med Econ. Nov. 2018 doi: 10.1080/13696998.2018.1511567


BACKGROUND/OBJECTIVE: Although biosimilar drugs may be cheaper to purchase than reference biological products, they may not be the most cost-effective treatment to achieve a desired outcome. The analysis reported here compared the overall costs to achieve live birth using the reference follitropin alfa (GONAL-f) or a biosimilar (Ovaleap) in Spain, Italy and Germany. METHODS: Patient and treatment data was obtained from published sources; assisted-reproductive technology, gonadotropin, follow-up and adverse-event-related costs were calculated from tariffs and reimbursement frameworks for each country. Incremental cost-effectiveness ratios (ICERs) were calculated from the difference in costs between reference and biosimilar in each country, divided by the difference in live-birth rates. Mean cost per live birth was calculated as total costs divided by the live-birth rate. RESULTS: The published live birth rates were 32.2% (reference) and 26.8% (biosimilar). Drug costs per patient were higher for the reference recombinant human follicle-stimulating hormone in all three countries, with larger cost differences in Germany (euro157.38) and Italy (euro141.50) than in Spain (euro22.41). The ICER for the reference product compared with the biosimilar was euro2917.47 in Germany, euro415.43 in Spain and euro2623.09 in Italy. However, the overall cost per live birth was higher for the biosimilar in all three countries (Germany euro8135.04 vs. euro9185.34; Italy euro8545.22 vs. euro9733.37; Spain euro14,859.53 vs. euro17,767.19). Uncertainty in efficacy, mean gonadotropin dose and costs did not have a strong effect on the ICERs. CONCLUSIONS: When considering live birth outcomes, treatment with the reference follitropin alfa was more cost effective than treatment with the biosimilar follitropin alfa.