ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
This article is part of the Research TopicReal-World Evidence and its Impact on Sustainable Health Financing, Economics and OutcomesView all 6 articles
An Analysis of Cost-Savings Due to the Introduction of Epoetin alfa Biosimilars in Germany in the German Statutory Health System
Provisionally accepted
- 1Sandoz Deutschland / Hexal AG, Holzkirchen, Germany
- 2Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Aims: Epoetin alfa, an erythropoiesis-stimulating agent, is the mainstay for treating severe anaemia caused by kidney disease or induced by cancer-chemotherapy. This study aims to investigate the potential of reducing drug costs through the utilisation of epoetin alfa biosimilars within the German statutory health insurance system (SHI). Methods: For the analysis, price and product data from ABDATA with sales volume data from IQVIA Pharmascope for the period from 2008 to 2023 were pooled. This enabled a comparison of cost savings due to the market introduction of epoetin alfa biosimilars from 2007 onwards. Results: From 2008 to 2023, overall epoetin alfa unit volume has increased by a total of 23%. Compared to the other epoetin derivatives such as, epoetin beta, zeta and theta, an average unit share of 57% (between 2008 and 2023) highlights the importance of epoetin alfa within the segment of erythropoiesis-stimulating agents. Among the various dosing strengths of epoetin alfa, the nephrological strength 4,000 IU formulation has gained notable sales growth (12%) from 2008 to 2023. Economically, the introduction of epoetin alfa biosimilars has led to substantial cost-savings for the SHI, amounting to €505,731,202 between 2008 and 2023 for nephrological strengths. Due to biosimilar competition, the price of epoetin alfa decreased by 47% from 2007 to 2012, further contributing to the diminished price difference between originator epoetin and other epoetin alfa biosimilars. Notably, the 4,000 IU nephrological strength alone accounted for savings of €143,720,363, reflecting its widespread clinical adoption. Conclusions: The introduction of epoetin alfa biosimilars has not only enhanced clinical accessibility, but also yielded significant cost savings for the German healthcare system. This underscores the dual role of biosimilars in improving healthcare affordability and maintaining effective therapeutic outcomes.
Keywords: biosimilars, Epoetin alfa, cost-savings, Germany, German Statutory HealthSystem
Received: 16 Jul 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Raitner, Müller, Vijayan, Bramlage, Ness and Müller. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Peter Bramlage, submission@ippmed.de
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