Study Shows Association Between Health Literacy and Patient Satisfaction With Switching to Biosimilar

Research presented at the European League Against Rheumatism’s Annual European Congress of Rheumatology concluded that patients’ attitudes and level of satisfaction with switching to a biosimilar for etanercept or infliximab was associated with their level of health literacy, defined as being given sufficient and necessary information concerning their health.  
Jackie Syrop
June 28, 2018
Researchers found that 80% of patients taking originator etanercept (Enbrel) or originator infliximab (Remicade) who were switched to less expensive biosimilars reported being satisfied or neutral about being switched to a less expensive biosimilar medication. Nearly 1 in 5 patients reported being dissatisfied with the switch to a biosimilar medication. The researchers said that the patients’ attitudes and level of satisfaction with the biosimilar switch were associated with their level of health literacy, defined by the researchers as being given sufficient and necessary information concerning their health.

The study’s findings were presented by Milada Cvancarova Smastuen, PhD, and colleagues at the European League Against Rheumatism’s Annual European Congress of Rheumatology, held June 13-16, 2018, in Amsterdam.

Of the 290 Norwegian patients in the original study group taking Enbrel and Remicade, 155 reported being switched to a biosimilar. Only 14% of switched patients reported being involved in the decision to switch to a biosimilar. The researchers noted that economically motivated switching to biosimilar medications from originator biological medications has been in practice in Norway since 2016. 

Data on patients’ attitudes toward, and experiences with, biosimilar switching were gathered from several questionnaires administered via a web survey in January 2017, which also collected demographic information such as gender, age, and marital status. Patients’ health-related literacy was measured using the Health Literacy Questionnaire, a multidimensional validated questionnaire. The investigators used 3 domains covering patients’ ability to actively engage with healthcare providers (scale 6), ability to find good health information (scale 8), and understanding health information well enough to know what to do (scale 9). Data were analyzed using multiple logistic regression and results were expressed as odds for being satisfied with the switch.

The authors found that self-assessed good health was strongly associated with a higher probability of being satisfied with the switch; only 9 of 74 patients who reported poor health also reported being satisfied. Adjusted for age and health self-assessment, scales 6 and 8 (but not 9) were significantly associated with higher odds of being satisfied with being switched (odds ration [OR], 2.5; 95% CI, 1.2-5.2 and OR, 2.7; 95% CI, 1.2-5.9, respectively).

The study also observed that:
  • The median age of patients who were switched was 51 years (range 20-74)
  • Older patients often reported being more satisfied than younger patients
  • The majority of survey respondents were women (61%)
  • 51% of respondents had completed higher education 

Pfizer financially supported the study through an unrestricted grant.

Smastuen MC, Brandvold M, Andenaes R. Is patient satisfaction with being switched to a biosimilar medication associated with their level of health literacy? Results from a Norwegian user survey. Ann Rheum Dis. 2018;77(Suppl 2):86.


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