An infliximab biosimilar switching programme, overseen by a specialist pharmacist, has demonstrated financial savings and therapy optimisation.
The parity of efficacy and safety of the biosimilar infliximab (IFX) has been demonstrated with data on switching still emerging. Specialist gastroenterology pharmacists are ideally placed to manage medicines optimisation and therapeutic drug monitoring (TDM), overseeing the switch, realising considerable cost savings and income through negotiations with commissioners.
A payment of £1250 per patient was negotiated to fund the switch. Seventy one patients (60 with Crohn’s Disease and 11 with ulcerative colitis) were switched, realising an income of £88,750 which was used to fund a specialist IBD nurse. No patient requested an additional appointment due to the pharmacist conducting counselling during infusion clinics prior to the switch.
Active management of treatment around the switch by the specialist IBD pharmacist saves money, realises investment into the service, optimises therapy in a timely manner and reduces outpatient appointments.
Seventeen patients stopped IFX: seven due to antibodies, two due to loss of response (LOR) and need for surgery, and eight patients were changed to alternatives by MDT review.
Fifty four patients continued on IFX infusions without experiencing LOR in the following six months. Savings on drugs was £224,000 and overall £300,000 (see table below).
TDM results were analysed by the pharmacist who initiated 14 dose adjustments, preventing 28 clinic appointments. CRP and IBD scores were reviewed at each infusion. A minority of patients submitted FCLP pre and post, preventing meaningful analysis.
It was concluded that switching to biosimilar IFX is safe. Active management of treatment around the switch by the specialist IBD pharmacist saves money, realises investment into the service, optimises therapy in a timely manner and reduces outpatient appointments.
IBD pharmacists are familiar with TDM and management of IBD patients and are able to negotiate with commissioners directly.