The impact of biosimilar use on healthcare utilization among new users of etanercept for inflammatory arthritis: a population-based regression discontinuity analysis

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-04-11 DOI:10.1016/j.lana.2025.101058

Vivienne Yuetong Zhou , Diane Lacaille , Yufei Zheng , Yi Qian , Bohdan Nosyk , Hui Xie

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引用次数: 0

Abstract

Background

Epidemiological evidence on biosimilars’ real-world performance is limited. On July 18th, 2017, a biosimilar health policy was implemented in British Columbia (BC), Canada, mandating all patients initiating a new biologic medication to be prescribed a biosimilar (if/when available). Exploiting a policy change as a natural experiment, we assessed the real-world impact of biosimilar use for inflammatory arthritis (IA) on health resource utilization as a surrogate marker of real-world effectiveness and safety.

Methods

Using administrative health data, we identified all incident etanercept users for IA in BC with initiation dates between 2014 and 2020 (n = 3004) [63·6% female; mean (S.D.) age at IA disease diagnosis 52·5 (16·6) years]. Healthcare utilization over three years after initiation was assessed using outcomes including — physician visits (PV), all-cause hospitalizations (ACH), infection-related hospitalizations (IRH), length of hospital stays (LOS), and emergency room visits (ERV). Using regression discontinuity design, we compared healthcare utilization risk in patients initiating etanercept immediately before/after policy-change date, representing the intention-to-treat effect. Additionally, we estimated the complier average causal effect of biosimilar use with instrumental variable (IV) control function method.

Findings

Intention-to-treat analyses showed no significant impact of biosimilar policy implementation on PV, HOSP, IRH, LOS, or ERV, with respective adjusted RRs of 0·96 (95% CI: 0·82–1·12), 0·84 (95% CI: 0·49–1·44), 0·91 (95% CI: 0·21–3·86), 0·94 (95% CI: 0·41–2·15), and 0·91 (95% CI: 0·44–1·88). IV analyses indicated biosimilar use in routine settings did not significantly change healthcare utilization, compared to originator etanercept.

Interpretation

No significant impact of biosimilar policy or actual biosimilar use on healthcare utilization was observed, suggesting equivalent real-world effectiveness and safety of biosimilars to originators and no unintended consequences of the policy change.

Funding

CHIR and NSERC.

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.