title: Budget impact analysis on erythropoiesis-stimulating agents use for the management of chemotherapy-induced anaemia in Greece.
abstract: BACKGROUND
  Chemotherapy-induced anaemia is a common and significant complication of chemotherapy treatment. Blood transfusion and administration of Erythropoiesis-Stimulating Agents (ESAs) either alone or in combination with iron are the most widely used therapeutic options. In Greece, ESAs are among the top ten therapeutic groups with the highest pharmaceutical expenditure, since they are fully reimbursed by social security funds. The objective of the study is to determine potential cost savings related with the use of biosimilar over originator ESAs for the management of the newly diagnosed chemotherapy-induced anemic patients.
  
  
  METHODS
  A budget impact analysis has been carried through the elaboration of national epidemiological, clinical and economic data. Epidemiological data derived from WHO (GLOBOCAN) and the European Cancer Anaemia Survey. Clinical data reflect oncology patients' disease management. ESAs consumption was based on data from the biggest social security fund (IKA). The administration of ESAs under different dosing schemes and time periods has been estimated by separating them in originators and biosimilars as well as by classifying anaemic patients in responders and non-responders. Cost analysis is based on newly diagnosed patients' alternative treatment scenarios. Treatment costs and prices are used in 2012 values. The Social Security Funds's perspective was undertaken.
  
  
  RESULTS
  Based on the annual incidence rates, 2.551 newly diagnosed chemotherapy-induced anemic patients are expected to be treated with ESAs. Average cost of treatment on originators ESAs for responders is €2.887 for the 15-week ESAs treatment and €5.019 for non-responders, while on biosimilars €2.623 and €4.009 respectively. Treatment cost on biosimilars is 10.1% lower than originators for responders and 25.2% for non-responders. Budget impact estimates show that treating anemic patients with originator ESAs was estimated at €10.084.800 compared to €8.460.119 when biosimilar ESAs were used, leading to an overall 19,20% cost reduction favoring biosimilars.
  
  
  CONCLUSIONS
  In Greece, the treatment on biosimilar ESAs seems to be a cost saving option over originators for the newly diagnosed chemotherapy-induced anemic patients, since it corresponds to 5% of the annual overall consumption and expands patients' access to ESAs treatment. Health care decision making should rely on evidence based treatments in order to achieve social funds' sustainability in an era of economic recession.
authors.affiliation: School of Social Sciences, University of Peloponnese, Corinth, Greece.
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Nikolaidi
authors.affiliation: School of Social Sciences, University of Peloponnese, Corinth, Greece.
authors.forename: Magdalini
authors.initials: M
authors.lastname: Hatzikou
authors.affiliation: School of Social Sciences, University of Peloponnese, Corinth, Greece.
authors.forename: Mary
authors.initials: M
authors.lastname: Geitona