Published: Value in Health, 2017
Objectives
Switching stable patients from branded biologics to biosimilars may offer potential cost savings through discounted drug prices however little is known about the impact on NHS resource use and the cost of service level activities. This study aimed to describe and quantify the impact on NHS resource use and the cost of service level activities required to conduct an originator biologic to biosimilar switch
Methods
This study was conducted in three UK rheumatology centres using a mixed methodology: (1) Semi-structured one-to-one interviews with key staff members involved in a recent Enbrel® to Benepali® switch to determine activities involved in the switch process, (2) Collecting service level data to quantify time and resource associated with switch activities. For each centre, a description of the switch model was developed and associated costs calculated using published NHS reference costs.
Results
Similar costs for switch planning activities (£12,638-£ 15,276) were observed across all three centres. Switch implementation and follow-up costs varied between £6,975 and £61,386 per centre depending on the model used. Key factors influencing the implementation cost included the use of dedicated switch vs. routine outpatient clinics, patient education and consent methods, and inclusion of additional post-switch monitoring clinic appointments. Overall, between 320 and 987 hours of staff time was spent on the switch per centre (estimated 149-176 patients switched per centre).
Conclusion
Switching from a biologic to a biosimilar was shown to be associated with additional NHS activities and resource use which should be considered by NHS stakeholders alongside potential drug cost savings. This study quantifies real-world resource costs associated with different switch models selected by centres to meet perceived patient needs. Costings varied considerably, reflecting differing numbers of patients switched and services provided. A fourth centre will be added and further work required to understand patient experience of the switch.
