Rituximab Biosimilars Linked to Cost Savings

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The rituximab biosimilar rixathon was linked to the the lowest average annual cost per patient across 6 indications among all biosimilars.

Cost savings were observed among rituximab biosimilars in all approved indications compared with the reference drug, according to a study published in Journal of Medical Economics.1 Among a cohort of Jordanian patients, the biosimilar rixathon was linked to the lowest annual cost, highest percentage of expanded patient access for 6 indications, and the lowest number-needed-to-convert (NNC) providing access to 10 additional patients.

Biologics, such as rituximab, have advanced the treatment of an array of diseases. However, their high costs are often a burden on healthcare budgets globally. Patent expiration has created the opportunity to develop and market biosimilar drugs at a lower price point, enabling patients to be treated at lower costs. These drugs can provide more patients with access to supplemental care on a budget neutral basis.2

“The present study is part of a series of cost-efficiency and expanded access analyses quantifying the clinical and economic value of different biosimilars, first in Europe, later in the United States, and now also including emerging markets, with Jordan being the first,” Nimer Alkhatib, PhD, Faculty of Pharmacy, Al-Zaytoonah University of Jordan and Center for Health Outcomes and Pharmaco Economic Research, University of Arizona, and colleagues. “We report here on a study that aimed to quantify the cost-efficiency and expanded treatment access of conversion to rituximab biosimilars from reference rituximab in Jordan. To our knowledge, this is the first cost-efficiency study of rituximab from the public (governmental) health payer perspective in Jordan (ie, the Jordanian Ministry of Health) and the first such study outside high-income countries.”

Investigators evaluated the total annual cost to treat a hypothetical patient, NNC to supply 10 additional patients access to rituximab therapy, head-to-head cost comparison, changes in access to rituximab, and the relative amount of Jordanian Dinar (JOD) spent on rituximab options. The NNC was defined as the number of patients needed to be converted from a higher-cost option to a lower-cost option to increase the treatment coverage for additional patients.

1-year cost-efficacy was determined and compared between the reference product and approved biosimilars (rixathon, tromax, and truxima). The model included rituximab doses at 100mg/10ml and 500mg/50ml. The costs of treatments were based on 2022 tender prices received by the Joint Procurement Department (JPD).

The biosimilar rixathon was linked to the the lowest average annual cost per patient (JOD 2860) across 6 indications among all rituximab biosimilars, followed by truxima (JOD 4240), tromax (JOD 4365), and the reference drug (JOD 11,431). The highest percentage of access to rituximab treatment (321%) was obtained by patients switching from rituximab to rixathon in the rheumatoid arthritis (RA) and pemphigus vulgaris (PV) indications. Rixathon was associated with the lowest NNC to provide 10 additional patients access to rituximab treatment in 4 patients.

Regarding cost, for each JOD1 spent on rixathon treatment, an additional .53 was spent on truxima, .55 on tromax, and 3.21 on the reference product.

Investigators noted because patient-level data was lacking in Jordan, the study simulated the treatment of a hypothetical patient. Further, the uptake of subcutaneous rituximab was not included in the study as the clinical advantage of subcutaneous rituximab compared with intravenous rituximab has not been confirmed.

“Further, real-world research on the patterns of conversion to biosimilars and patients’ unmet needs could provide payers, providers, decision makers, and patients more informative insights about the factors that influence the selection of rituximab biosimilars for a specific jurisdiction,” investigators concluded.


  1. Halawah HH, Alkhatib NS, Almutairi AR, et al. Cost-efficiency analysis and expanded treatment access modeling of conversion to rituximab biosimilars from reference rituximab in Jordan [published online ahead of print, 2023 Jun 15]. J Med Econ. 2023;1-31. doi:10.1080/13696998.2023.2226007
  2. Aapro M, Cornes P, Sun D, et al. Comparative cost efficiency across the European G5 countries of originators and a biosimilar erythropoiesis-stimulating agent to manage chemotherapy-induced anemia in patients with cancer. Ther Adv Med Oncol. 2012;4(3):95-105