The work described here was presented at the UKCPA Virtual Conference Poster Day 2021
Infliximab and its biosimilars are hospital-only biological medicines licensed for chronic inflammatory conditions. ‘Best value’ infliximab is the brand with the lowest acquisition cost. Whilst switching from an originator to a biosimilar is common practice within the NHS, switching between biosimilars is novel.
In 2019/20, North Central London (NCL) Trusts spent £3.2 million on infliximab, of which the majority was biosimilar infliximab (Remsima®). In September 2019 a revised procurement contract came into effect and a new biosimilar infliximab (Zessly®) became ‘best value’. Delayed or incomplete uptake of ‘best value’ infliximab would reduce the opportunity for reinvestment in population health; within NCL this amounted to £650,000 per annum.
We undertook a regionally coordinated quality improvement project to adopt ‘best value’ infliximab for the Clinical Commissioning Group (CCG) commissioned indications in eight departments across four acute providers within NCL. The aim was for new patients to initiate and existing patients to make an informed choice to switch to ‘best value’ infliximab.
The NCL Joint Formulary Committee reviewed the evidence base and recommended a biosimilar-to-biosimilar switch. Project support was obtained from clinical champions, regional Chief Pharmacists and Medical Directors. At a regional level, patient letters were developed for local adaptation and a biosimilar helpline was set up for patients.
The aim was for new patients to initiate and existing patients to make an informed choice to switch to ‘best value’ infliximab
Following the decision to proceed at each Trust, local teams comprising of pharmacy, consultant and nurse leads were established to implement the switch. Teams were supported by a regional pharmacist to share best practice. Existing patients received written information about the proposal to switch and had the opportunity to ask questions before their next infusion.
We aimed to measure the percentage of ‘best value’ infliximab dispensing for CCG commissioned indications, with a goal of 80 percent or greater within four months. We also collected data on the number of departments that completed the transition and the number of patients who agreed to switch, as well as infusion reactions with ‘best value’ infliximab and requests to switch back.
The goal of dispensing 80 percent ‘best value’ infliximab took eight months. 561 patients received ‘best value’ infliximab, of which 79 percent had switched. Six of eight departments completed the transition within this period.
Delays were caused by changes to contract arrangements and local factors, such as specialist nurse reallocation due to COVID-19, competing biosimilar switch programmes and difficulties in monitoring dispensing data at one Trust. No patients declined to switch. Five (0.9%) infusion reactions were reported and there were three (0.7%) requests to switch-back due to loss of efficacy.
Adopting a regional improvement approach to biosimilar switches was efficient, acceptable to patients and resulted in cost-avoidance. Switching between infliximab biosimilars appears to be safe and effective although randomised-controlled trials are needed to prove this. It would also be useful to know the extent of patient satisfaction.
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Competing interest statement:
The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.