UK Providers Seek More Real-World Evidence, Financial Incentives for Biosimilar Use

While the United Kingdom (UK) was a slow adopter of biosimilars compared with many of its European counterparts, recent years have seen a steady uptick in biosimilar use. A new qualitative study, using semistructured interviews with healthcare providers in the United Kingdom’s West Midlands region, sought to assess attitudes toward biosimilars in the clinical specialties of diabetes, inflammatory bowel disease, and rheumatology. 
 
Kelly Davio
November 21, 2018
While the United Kingdom (UK) was a slow adopter of biosimilars compared with many of its European counterparts, recent years have seen a steady uptick in biosimilar use. A new qualitative study, using semistructured interviews with healthcare providers in the United Kingdom’s West Midlands region, sought to assess attitudes toward biosimilars in the clinical specialties of diabetes, inflammatory bowel disease, and rheumatology. 

The interviews were conducted among 22 providers—comprising consultant physicians, nurses, and pharmacists—from 8 National Health Service (NHS) trusts. According to the researchers, 5 major themes emerged from the discussion with providers:

1. Healthcare providers expressed an understanding of biosimilars. The interviewees understood the differences between originator biologics and biosimilars, and gained their first knowledge of biosimilars through conferences, pharmaceutical industry representatives, journals, and colleagues. 

2. Most providers were comfortable with initiating treatment with biosimilars. However, most rheumatology and diabetes specialists would prefer to use the reference product if prices for both products were equal. 

While some rheumatology and diabetes specialists reported feeling pressured to use biosimilars rather than reference products, all gastroenterology specialists and some rheumatology specialists were content with prescribing biosimilars. 

All providers who were comfortable with switching to a biosimilar expressed the view that patients should be given a say in the switching process, and most providers had a negative view of automatic substitution. 

Approximately half of gastroenterology and rheumatology providers felt that cost savings from biosimilars should be shared between their departments and Clinical Commissioning Groups.

3. Gastroenterology providers expressed more confidence in biosimilars than other specialists did. Gastroenterology providers reported that they had overcome hesitance about the extrapolation of indications, and they said that adalimumab uptake would be easier than infliximab uptake because of growing experience with biosimilars. Rheumatology providers were more concerned about the extrapolation of indications. 

The majority of all providers, regardless of specialty, were hesitant to switch a patient multiple times on the basis of cost, and would prefer to keep a patient on a biosimilar if the patient responded well (rather than switch back to an originator product). 

4. Clinical experience and cost information are key to facilitating uptake. While gastroenterologists felt that guidance from the British Society of Gastroenterology and the National Institute for Health and Care Excellence, experience from other NHS trusts, and a national registry provide a basis for confident use of biosimilars, other practitioners sought more supportive evidence on the efficacy and safety of biosimilars from other trusts.

Understanding who would benefit from cost savings from biosimilars was the main reason reported for a delay in including biosimilars in a formulary, and some providers suggested that gain-sharing arrangements would influence their use of biosimilars. 

5. Providers would avoid biosimilars on the basis of adverse events (AEs). The majority of providers said that the development of unexpected AEs or increased side effects would cause them to avoid prescribing biosimilars. A majority of rheumatology specialists said that administration devices were also important for patients’ ease of use. 

The authors concluded that their study showed that UK providers have a good understanding of biosimilars, and that “Safety and efficacy concerns, patients’ opinion and how cost savings were shared were the identified barriers to considering prescribing biosimilars.” Finally, they wrote, “Real-life data and financial incentives were the suggested facilitators to increase biosimilar utilization.”

Reference
Aladul MI, Fitzpatrick RW, Chapman SR. Healthcare professionals’ perceptions and perspectives on biosimilar medicines and the barriers and facilitators to their prescribing in UK: a qualitative study. BMJ Open. 2018;8:e023603. doi: 10.1136/bmjopen-2018-023603.


 

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