POS0626 MONEY MATTERS: ASSESSING THE VALUE OF THE ADALIMUMAB BIOSIMILAR SWITCH FOR RHEUMATOLOGY PATIENTS
Authors: S. Gohil
Journal: Annals of the Rheumatic Diseases (2021)

Background: The adalimumab biosimilar switch plan, actioned 2018-19 was one of the most complex of all biologic switches across several specialties. Non-medical switches are considered to ensure the best value medicines are prescribed for patients in line with NICE Technology Appraisals. Objectives: This 2 year follow up review explores the value of the switch for Rheumatology (R) patients in comparison to two other major specialisms; Dermatology (R) and Gastroenterology (G). Methods: 403 homecare (HC) patients had been identified as eligible for switch to a citrate containing biosimilar (R;189, G;176, D;38) between April-December 2019. 35 hospital FP10 patients receiving the citrate-free originator biologic were also identified for switch to the citrate containing biosimilar and prescription processing via HC (R; 24, G; 9, D;2). Biosimilar switch information was communicated via patient letters/clinic reviews. FP10 patients also received remote pharmacist telephone support, as part of a PDSA (Plan, Do, Study, Act) quality improvement pilot. Data in regard to switch refusal, treatment cessation, withheld treatment and patient satisfaction ratings for pharmacist phonecalls (1 = unsatisfactory, 5=very satisfied) was documented. Results: 235/403 HC patients successfully switched (R;99, G;107, D;29). 64/403 HC patients switched back to the originator (R;47, G;12; D;5). Of the 64 switch back HC patients; 52% = reported lack of efficacy; 27% = injection site pain and 21% = various other factors such as blepharitis, insomnia and hair loss. 38/403 HC patients refused the switch and remained on the originator biologic (R;11, G;27, D;0). 31/403 HC patients switched to an alternative biologic (R;19, G;9, D;3). 32/403 HC patients stopped treatment (R;13, G;19, D;0). Treatment was withheld for 3/403 HC patients (R;0, G;2, D;1). 100% of FP10 patients switched to HC. 31/35 FP10 patients switched to the biosimilar (R; 22, G; 7, D; 2). 3/31 patients switched back to the originator due to lack of efficacy or side effects. 4 patients refused the switch to biosimilar (R;3, G;1, D;0). 89% of patients were very satisfied with the pharmacist telephone support. Conclusion: In summary, 58% of all eligible HC patients switched in comparison to 89% of FP10 patients who received pharmacist telephone support; total cost saving following HC and FP10 switch = £270,000. Rheumatology demonstrated the least success in HC switching (52%) and the highest HC switch back figure (25%). Injection site pain and subjective lack of efficacy appear to be the main reasons for ongoing switch backs. The PDSA project demonstrates that a thorough pharmacist assessment of patient concerns in rationalising the use of a biologic agent versus biosimilar can be valuable for patients. Further cost effective adalimumab biosimilars have recently been launched. This seminal review emphasises the ongoing need for robust critical appraisals of biosimilars, with consideration for both clinical and cost effective parameters, before establishing their placement in treatment pathways. Acknowledgements: Mark Easter, UHCW and Interim Integrated Care System Chief Pharmacist, Hardeep Bagga, Deputy Chief Pharmacist, UHCW Pharmacy Homecare Team and UHCW Specialist Rheumatology, Gastroenterology and Dermatology Clinical Teams. Disclosure of Interests: None declared