106 Switching stable rheumatology patients from an originator biologic to a biosimilar: resource cost in the UK

Abstract

Background: The National Institute for Health and Care Excellence (NICE) recommends several possible treatments including etanercept for people with severe rheumatoid arthritis, severe active ankylosing spondylitis and progressive psoriatic arthritis. Several brands of etanercept are now available including benepali≤, a biosimilar launched in February 2016 in the UK as an alternative to the originator biologic enbrel≤. Switching stable patients from branded biologics to biosimilars may offer potential cost savings through discounted drug prices, although little is known about the impact of switching treatments on NHS resource use and the cost of service-level activities required to conduct the switch. This study therefore aimed to describe additional service-level activities and associated NHS costs involved with carrying out an originator biologic to biosimilar switch. Methods: Semi-structured one-to-one interviews were conducted at four UK rheumatology centres with key NHS staff members involved in a recent enbrel to benepali non-medical switch (NMS), in order to determine the additional activities conducted by staff members during the switch. This information was combined with service-level data in order to estimate the cost of NHS staff time and resource use associated with carrying out these activities, using published NHS reference costs. Results: Between 320 and 1076 additional hours of staff time were estimated to have been spent on the NMS across the four centres, with between 149 and 180 patients switched per centre. Many activities were involved with planning for the switch including staff time associated with: identifying suitable patients; preparing and reviewing documentation; meetings, emails and phone-calls with staff members or external providers; patient and staff education. The estimated cost of additional staff time associated with switch planning ranged from £12,638 to £16,679 between centres. Estimated additional costs of switch implementation and follow-up activities per centre varied between £1,615 to £30,033, and £4,686 to £31,352, respectively, reflecting considerable variation in the specific approaches taken. Key cost drivers included the number of patients switched, the extent to which activities were shared with external homecare providers, the use of dedicated switch vs. routine outpatient clinics, time spent auditing and reporting about the switch, and the inclusion of additional postswitch clinic appointments to further monitor patients and address any related concerns. Conclusion: This study quantified real-world activity and resource use associated with a recent biologic to biosimilar non-medical switch at four UK centres. The findings suggest that NMS requires additional NHS activity and resource use which should be considered by NHS stakeholders alongside drug cost savings. The additional costings varied widely between centres, reflecting the different approaches chosen, numbers of patients switched, the specific services offered and clinical judgement of the individual needs of the patients being treated. Further research is required to understand patient satisfaction with the switch.