Effect of national tender system on the costs of biologic and targeted drugs in Norway

At the 2021 EULAR congress, Brkic and colleagues presented data from people with rheumatoid arthritis (RA) treated at Norwegian rheumatology outpatient clinics between 2010 and 2019.

The project BioRheuma (BIOlogic treatment of patients suffering from inflammatory RHEUMAtic disorders in Norway) aimed to monitor people receiving b/tsDMARDs. Anonymized data files from10 participating centres were merged and analyzed over a 10-year period to show the annual total b/tsDMARD cost, as well as the mean cost per patient for all current users, for all those who started treatment, and for initiating patients naïve to b/tsDMARDs.

The cost was calculated based on price offers given at the annual tender process for the different years.

The number of registered RA patients in the databases increased from 4909 in 2010 to 9335 in 2019, and the number of patients receiving b/tsDMARDs increased from 1959 (39.9%) in 2010 to 4209 (45.1%) in 2019.

The total treatment expenditure of these b/tsDMARD-treated patients was lowest in 2010(226 million Norwegian Kroner[NOK]), highest in 2014 (350 million NOK), and second lowest in 2019 (255 million NOK).

For current users of b/tsDMARDs, when the number of treated patients during follow-up doubled, the mean cost to treat one patient was reduced by approximately 50%.The number of patients starting on b/tsDMARDs roughly doubled, while keeping a steady small increase for naïve patients. These data show that the average annual costs of treating a Norwegian RA patient on a current b/tsDMARDs were reduced by approximately 50% over the ten years 2010-2019by the national tender system.

For patients starting on a b/tsDMARD, the average annual cost was reduced by approximately 75%. The consequence for payers is that treatment can be offered at a lower price, and thus costly drugs may become more available for patients. The authors believe that tender mechanisms applied to the commercial pharmaceutical market improve competition, and increase availability and use of costly drugs.