Copycat versions of biotech drugs work just as well as the originals and cost a lot less, according to an analysis of studies of the medicines.

The analysis by researchers at Johns Hopkins Bloomberg School of Public Health finds that so-called biosimilars — medications that are meant to mimic, and compete with, complex and expensive biotech drugs — perform as well as the brand-name versions.

The researchers looked at data from 19 studies of biosimilar drugs that treat rheumatoid arthritis, inflammatory bowel disease and psoriasis, and found that they were comparable to the originals and would cost less. The findings will appear in the Aug. 2 issue of Annals of Internal Medicine.

“Hopefully, this will encourage the brisk adoption of these products,” said Caleb Alexander, the study’s lead researcher, in a release. “There is no question that greater competition in this market will benefit patients, prescribers and society in the long run.”

Biologics include proteins and antibodies that are typically made by living organisms. They’re more difficult to produce than medications made from mixtures of chemicals. It’s also next to impossible to make an exact copy of a biological product, which is why the drugs are often referred to as biosimilars.

There was a provision in the Affordable Care Act meant to encourage development and approval of biosimilars, but progress has been slow. The Food and Drug Administration has approved only two such drugs since the law passed in 2010.

Zarxio, the first biosimilar drug approved in the U.S., is expected to save about $6 billion a year because it costs less than Amgen’s Neupogen, the brand-name product. The medications help boost the immune systems of chemotherapy patients by increasing production of white blood cells.

In April, the FDA approved a second drug that is similar to Johnson & Johnson’s Remicade to treat colitis and Crohn’s disease. That drug, called Inflectra, is one member of the class of biosimilars that the researchers at Johns Hopkins examined. There are several other biosimilar drugs in this class available in Canada, Asia and Europe.

The Johns Hopkins study is important because drugmakers have raised questions about biosimilars since they aren’t identical to the drug they’re supposed to mimic. Many are fighting approval of the drugs, and some argue that they should not be substituted for a brand-name drug without a patient’s consent.

But IMS Health Informatics says there are 50 biosimilars under development. All told, they could save U.S. and European health systems as much at $110 billion over the next five years, the company estimates.

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Mario Perez lives in Miami, but he was in Orlando for a housewarming party Saturday, June 11. After the party, the 34-year-old went to Pulse for Latin night.

At 2 a.m., he heard gunshots. Loud. He knew it was real.

“And the minute he started shooting, I got hit from the side, I got grazed by a bullet,” Perez says. “My first instinct was to fall to the floor, that’s what you’re taught to do.”

He heard gunshot after gunshot after gunshot. It was too many to count. But then there was a brief break in the firing, and Perez ran out the back of the club. He hid inside the kitchen of a nearby 7-Eleven until police and paramedics showed up. He was taken to Orlando Regional Medical Center, and was at the emergency room from 3 a.m. until 8 a.m.

The gunshot wound on his side is purple and swollen, and he has nerve damage from the bullet fragment. He cut his elbow from glass on the floor of the nightclub and received six stitches. Perez doesn’t know how much bills coming from specialists, X-rays or other tests may cost him. But his bill from Orlando Regional Medical Center’s emergency department: $20,000.

“$20,000,” Perez said. “That’s the quote, that’s what they told me.”

Perez has no health insurance. He’s working for a temp agency right now and doesn’t have the money to be seen by a doctor for follow-up care in Miami.

So just how much will the Pulse nightclub shooting cost all of the victims? It’s a difficult, if not impossible question to answer right now. At last check, there were 56 people brought to the hospital, including three patients who spent two weeks in the intensive care unit, and one patient is still in the hospital in critical condition.

Embry Howell is a senior fellow at the Urban Institute, a think tank in Washington, D.C. She studied the average cost of a gunshot victim in 2010. Using that benchmark, she estimates the hospital costs from the Pulse shooting will be about $1 million.

“And I would imagine that would be an underestimate,” Howell said.

Howell said many of the victims may be in the same boat as Mario Perez – uninsured.

“They’re young, primarily Latino and living in Florida,” she says, a state that has not expanded Medicaid to its population.

“My guess would be you have a high rate of uninsured,” she concludes.

Ted Miller is a researcher with the Pacific Institute for Research and Evaluation. He has been studying the cost of firearm injuries for more than two decades. He used the 2011 shooting of former Congresswoman Gabby Giffords and 18 others in Arizona to make what he calls a conservative estimate.

That estimate: $4 to $7 million dollars in medical costs and mental health costs for victims and survivors of people who died. That’s the lifetime medical costs for the survivors, the costs of surgery, the cost of rehab. But it doesn’t count the long-term costs for those who are severely injured.

“They said some time ago that there were six people in ICU who would have long time, serious consequences,” Miller said. “And my guess is most of those folks will have traumatic brain injuries that will have continuing lifetime care.”

Miller also makes a broader estimate beyond just the medical costs. That includes the cost of the police response, the cost to employers – and the dollar value of those 49 lost lives.

“I estimate that the total cost of the Orlando shooting is around $385 to $390 million,” Miller says. “To put that in context, on that same day, the cost of other gunshot wounds in the U.S. was probably about $600 million. So about one and a half times the cost of the Orlando incident. That tells you that there are a lot of people killed and injured by firearms every day in this country,” he says. And, he explains, “Suicide deaths account for the largest share of gun violence costs.”

What’s not included in Miller’s $385 million estimate is the cost of mental health counseling for people who were in the club but not physically shot – and friends and family of those there. And then there’s the cost of fear: People being afraid to go out to a dance club, or maybe skipping a visit to the theme parks.

Orlando Regional received 44 of the shooting victims. A hospital spokeswoman says some patients have insurance coverage, some don’t. The hospital is going to look for payment sources from the community or the state, such as victim funds that are raising money across the country. But she says the hospital expects unreimbursed costs of more than $5 million.

Pulse shooting victim Mario Perez is calculating his personal costs. He’s worried he’s going to lose his job. He’s anxious knowing millions of dollars have been raised to help victims, but his bills are arriving now. He started his own GoFundMe campaign but it’s only raised about $600.

“As long as it gets covered, I’m going to be fine,” Perez said. “If they don’t cover it, I’m stuck in a hole. I don’t know what I’m going to be able to do if they don’t assist me.”

This story is part of a reporting partnership with NPR, Health News Florida and Kaiser Health News.

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