Sapna Gohil
University Hospitals of Coventry and Warwickshire, United Kingdom
Title: Money matters: A review of cost effective biologic prescribing at a Large Acute University Hospital
Biography
Biography: Sapna Gohil
Abstract
The practice of non-medical switching between originator biologic medicines and biosimilars resonates with recommendations from Lord Carter’s 2016 UK report regarding adoption of cost saving opportunities. In 2018/19, UHCW actioned one of the largest non-medical biosimilar switches for adalimumab.
This quantitative review explores the success of the adalimumab biosimilar switch and key themes associated with switch backs/refusals across the Dermatology (D), Rheumatology (R) and Gastroenterology (G) specialities at UHCW.
403 patients eligible for switch (R;189, G;176, D; 38) were considered between April-December 2019. Patients were informed in advance via a patient information leaflet/hospital clinic visits. Switch refusals, withheld treatments and cancellations were documented. Clinicians would provide alternative management plans for patients who reported significant concerns post switch.
264/403 patients successfully switched (R;122, G;109, D;33). 33/403 patients switched back to the originator (R;22, G;10; D;1). Of the 33 switch back patients; 12(36%)=reported lack of efficacy; 8(24%)=injection site pain and 13(39%)=various other factors such as blepharitis, unstable disease and pregnancy.
38/403 patients refused the switch and remained on the originator biologic (R;11, G;27, D;0). 29/403 patients switched to an alternative biologic (R;17, G;9, D;3). 32/403 patients stopped treatment (R;13, G;19, D;0). Treatment was withheld for 7/403 patients (R;4, G;2, D;1).
In summary, 66% of all eligible patients switched; thus an annual cost saving of £73,020. Dermatology achieved the most success in switching 87% of their patients. Injection site pain and subjective lack of efficacy were the predominant causative themes for switch backs.