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As Device Design Becomes a Way to Differentiate Biosimilars, What Do Patients Prefer?


Along with innovations in design comes the question of patients’ willingness to pay for features that differentiate self-injection devices from one another.

Device design is becoming an important part of biosimilars’ positioning in the marketplace as drug makers seek to differentiate themselves from rivals with devices that are easy for patients to use for self-administration of therapies, and biosimilar developers are beginning to accrue data for their device designs in terms of patient and nurse preference.

In one recent study, patients with inflammatory diseases and nurses preferred the autoinjector for biosimilar adalimumab, Imraldi, over autoinjectors for reference adalimumab or reference etanercept.1 Another study found that patients with rheumatoid arthritis (RA) preferred the autoinjector for Sandoz’s biosimilar etanercept, Erelzi, to reference etanercept, another biosimilar etanercept (Benepali), and reference adalimumab.2

In addition to ease of use, biosimilar developers are also considering environmental responsibility; just this week, Gedeon Richter announced that its newly launched teriparatide biosimilar (Terrosa, Movimya) will be available in a reusable, environmentally sustainable pen that will last for a full 2-year treatment cycle for osteoporosis.

Along with these innovations in design, however, comes the question of patients’ willingness to pay (WTP) for features that differentiate self-injection devices from one another. A recent paper reported on efforts to assess rheumatology patients’ preferences and WTP for a variety of features of self-injection devices, and to investigate what differences may exist among patients with different inflammatory diseases.3

Physicians in the United Kingdom invited patients with RA, psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) to complete a discrete-choice survey electronically. The patients, 323 of whom agreed to complete the survey, were given 10 choices between 3 different devices: a free, standard disposable device and 2 hypothetical reusable devices characterized by the presence or absence of a variety of enhancements.

Every hypothetical device included a cost to assess patients’ WTP for the enhanced features. Of the features offered, patients most preferred the following, in descending order:

  • Skin sensor (WTP, £30; US $36)
  • Injection speed control (WTP, £20; US $24)
  • Injection reminders (WTP, £20; US $24)
  • Electronic log (WTP, £20; US $24)
  • On-screen instructions (£12; US $15)

Respondents generally preferred devices that offered any of the enhanced features proposed, excluding grip size (patients with axSpA preferred a small grip, while patient with PsA preferred a large grip).

On average, respondents were willing to pay £85 (US $103) for a reusable device with all enhanced features, but there were variations by group in terms of what patients were willing to pay; patients with RA and those who had no self-injection experience were willing to pay the most (£130 and £145, respectively; US $158 and $176). Patients with self-injection experience, however, were willing to pay just £35 (US $42) for the same hypothetical device; the authors say that this finding may be because patients with no injection experience may have anxieties about self-administering therapy and may need more support than those who have a routine and need less assistance.

The researchers also found that patients with axSpA had a statistically significant preference for a disposable standard device, while patients with RA and PsA did not have a strong preference between the standard disposable device and a reusable device.

Patients whose physicians assessed their disease as severe significantly preferred a disposable standard device, but those with moderate disease severity preferred a reusable device. Patients with experience self-injecting their treatment were more likely to select a disposable standard device.

Notably, UK patients typically pay little to no share of their device costs, so repeating such a survey in a different healthcare system, like that of the United States, write the authors, might find that patients are willing to pay more for the same device.


1. Fenwick S, Thakur K, Munro D. Nurse and patient perceptions and preferences for subcutaneous autoinjectors for inflammatory joint or bowel disease: findings from a European survey [published online February 21, 2019]. Rheumatol Ther. doi: 10.1007/s40744-019-0144-8.

2. Tischer B, Mehl A. Patients’ and nurses preferences for autoinjectors for rheumatoid arthritis: results of a European survey. Patient Prefer Adherence. 2018;2(12):1413-1424. doi: 10.2147/PPA.S169339.

3. Boeri M, Szegvari B, Hauber B, et al. From drug-delivery device to disease management tool: a study of preferences for enhanced features in next-generation self-injection devices. 2019;13:1093-1110. Patient Prefer Adherence. doi: 10.2147/PPA.S203775.

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