P054 Utilising a pharmacist-designed best value biologic and targeted synthetic shared decision-making tool to empower patients, support clinicians and save NHS resources
Authors: Mathews Nidhimol , McKenzie Colm , Rose-Parfitt Emily 
Published: April 2023

Abstract

Background/Aims
The dynamic pipeline and complex pricing of b/tsDMARD therapies make it challenging for clinicians to compare cost of treatments when undertaking shared decision making with patients in the clinic setting. NHSE have funded development of a Rheumatology Pharmacist designed, web based, best value biologic and targeted synthetic shared decision-making tool (BVBTS-SDMT) using live pricing from the Commercial Medicines Unit. A clinical workbook and treatment pathways have been developed to support the tool. Clinical parameters are entered into the tool, creating a list of available therapies in order of increasing cost relative to the patient’s weight and indication. Treatment pathways are consulted and clinical parameters (e.g. disease phenotype, co-morbidities, response to previous treatment) and patient preferences (e.g. route and frequency of administration, frequency of drug monitoring, personal beliefs) are discussed with the patient and documented in the clinical workbook. Inappropriate therapies are eliminated, identifying the most cost-effective treatment option for the patient synchronously during the consultation. This study explores the potential patient, clinician and cost benefits of adopting the tool in practice.

Methods
A random sample of 51 patients referred to the rheumatology non-medical prescribing team for starting b/tsDMARDs between 2019 and 2022 were recruited. Electronic records including referral email, patient notes and b/tsDMARD database were evaluated and recorded factors influencing shared decision making were analysed. Two rheumatology specialist pharmacists independently reviewed the historical clinical decision making to determine if the most cost-effective treatment option was chosen once all clinical factors and patient parameters were considered, using a record of historic treatment prices from retrospective homecare invoices and commissioning reports. Differentials between most cost-effective treatment and chosen treatment were calculated. Secondary outcome of comprehensiveness of clinical record was also analysed.

Results
Between 2019-2022, use of the BVBTS-SDMT would have saved an average of £1,695 per patient in the n = 51 sample. For the 210, 173 and 258 patients newly started on b/tsDMARDs in the years 2019-2020, 2020-21 and 2021-22 respectively, a total of £1,086,495 would have been saved if the tool had been in use. Clinical parameters, patient preferences and cost consideration affecting shared decision making were documented in 49%, 12% and 0% (respectively) of the 51 recruited patients’ clinical records.

Conclusion
This baseline data collection demonstrates use of the BVBTS-SDMT, in collaboration with treatment pathways and a clinical workbook, has potential to facilitate robust, consistent and methodological shared decision making with patients, encourage accurate reporting in patient records and save NHS money. This is a transformative approach to shared decision making; deviating from the traditional method of giving patients a couple of options to consider and instead working collaboratively through a shared decision-making process to find the most appropriate and cost-effective treatment option for the patient.
Disclosure
N. Mathews: None. C. McKenzie: None. E. Rose-Parfitt: None.