061 What factors predict good patient experiences of switching from reference etanercept to an etanercept biosimilar in a South West London general hospital?

Abstract

Background: Development of cheaper biosimilar (BS) drugs, analogous to existing biological drugs (BG), has cost benefits for inflammatory arthritis (IA) treatment. In 2016, our hospital's rheumatology department switched patients on reference etanercept (E) to an etanercept biosimilar (B). Patients were informed of their switch during a routine clinic appointment or by letter/phone. In non-privatised healthcare, it is inevitable that hospitals will continue switching patients from BG to their BS counterparts once efficacy, safety and licensing rights are established. Little is known about how best to switch patients. We devised a questionnaire to investigate our patients' experiences of switching and gain feedback on factors needing improvement. Methods: In May 2017, 355 anonymised questionnaires were sent to our patients with IA who had switched from E to B. We received 107 responses. Questions were semi-structured using Likert scales and focused on diagnosis, treatment history, how patients were informed of their switch and any effects they had from the switch itself. Results: Rheumatoid arthritis represented 68% of patients, psoriatic arthritis 16% and ankylosing spondylitis 11%. 64% were female, 36% male. 20% were 18-49 years and 80% were ≤ 50 years. 29% of patients had a disease duration of 1-10 years and 71% > 10 years. 44% were on monotherapy and 39% combined with methotrexate. 65% of patients were informed of switching by their rheumatology doctor, the remainder by their nurse/delivery company. 90% of patients were informed in person with the remainder by phone/letter. 6% of patients were not given any information about B, the rest were given verbal/written information. 45% of patients found their switching experience excellent/very good. 44% was satisfactory, 9% found their experience poor/very poor - from those patients 32% expressed that their experiences would have improved if they were given the option of switching and 21% if they were given more information about B. 39% experienced side effects (SE) whilst switching. Factors significantly affecting patients' having a poor switching experience were longer disease duration (p 0.042), not feeling supported (p 0.000000079) and experiencing SE after switching (p 0.0018). There were no significant differences when looking at age, gender, the clinician grade informing the patient of the switch, whether patients were informed in person or by phone/letter, or the type of information patients were given about the switch (verbal/written). Conclusion: Switching onto B is a phenomenon likely to continue with a need to improve patients' experiences of switching. Longer disease duration, less support from clinicians and SE from switching contribute to poor experiences. Reducing SE in patients who have switched is fundamental, including those occurring via the nocebo effect. Giving adequate information, having opportunities to ask questions, and a point of contact after switching are factors that patients express as important.