P008 Improving patient care cost-effectively through a virtual rheumatology biologic clinic
Authors: Whiteman J , Maiden N , Wylie E , McGoldrick V , Walker S , Liggett N , Neville L-A , McAteer C , Boyce T , McWilliams L-A 
Published: April 2021

Background/Aims 

There are currently around 1,000 rheumatology patients on biologic therapy in the Southern Health and Social Care Trust (SHSCT) with annual growth of &gt; 15%. Challenges facing the Rheumatology Biologics Service include: Continued increase in demand for biologics which makes timely review and management of patients difficult to maintain; Increased availability of approved treatments for inflammatory disease which makes drug choice difficult; Regional budget constraints and the need to comply with regional efficiency savings. Expenditure in SHSCT for rheumatology biologics in 2019 was over £5.5 million. A new service model, the multidisciplinary Virtual Rheumatology Biologics Clinic (VRBC) was established to address some of the challenges facing the Rheumatology Biologics Service.

Methods 

The VRBC was introduced in May 2019 after a successful ‘Invest to Save’ proposal to the Health and Social Care Board by the lead clinician (NM). Detailed biologic drug pathways reflective of drug cost, current guidelines and patient factors and a drug tapering protocol were agreed by the rheumatology team. Each week appropriate patients were identified who were either stable and 'in remission’, had grumbling disease and needed a treatment consideration or could be switched to a biosimilar drug. Treatment recommendations were made and communicated to the clinicians seeing these patients in clinic the following week. The aim of the VRBC was to: Improve the care provided to patients by facilitating multidisciplinary review of patients; Facilitate medicines optimisation enabling a minimum 5% reduction in 2019 expenditure on biologic drugs; Introduce tapering of the biologic doses of patients in stable remission for 10% of patients.

Results 

In the first 24 weeks of the VRBC, 928 patients attended biologic review clinics. Treatment recommendations were implemented in 283 (30%) patients. 172 patients were switched to biosimilar drug, 56 patients had their biologic drug changed to an alternative and 50 had their dose of biologic tapered. Going forward, switching of these 172 patients will lead to savings of £30,078 per month on biologic spend. Optimisation of biologic drugs will lead to savings of £4,592/month in 56 patients and tapering of drug dose will lead to savings of approximately £11,335/month in 50 patients going forward.

Conclusion 

Regular virtual clinics have facilitated multidisciplinary review of biologic patients and medicines optimisation within Rheumatology. Clinicians choose biologic drug based on safety, evidence-based guidelines, patient factors and cost. Drug dose tapering was achieved in 5.4% (n = 50) of patients seen at clinic. This number will increase as the clinic progresses because patients newly switched to biosimilar drugs were not considered for tapering. A 5% reduction in expenditure on biologic drugs last year is achievable through dose tapering and choice of cost-effective drugs.

Disclosure 

J. Whiteman: None. N. Maiden: None. E. Wylie: None. V. McGoldrick: None. S. Walker: None. N. Liggett: None. L. Neville: None. C. McAteer: None. T. Boyce: None. L. McWilliams: None.