1
|
Galbraith AA, Price J, Abraham C, Giardino AP. Principles of Child Health Care Financing. Pediatrics 2023; 152:e2023063283. [PMID: 37635688 DOI: 10.1542/peds.2023-063283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
The American Academy of Pediatrics believes that the United States can and should ensure that all children, adolescents, and young adults from birth through the age of 26 years who reside within its borders have affordable access to high-quality comprehensive health care. Comprehensive, high-quality care addresses issues, challenges, and opportunities unique to children and young adults and addresses the effects of historic and present inequities. All families should have equitable access to professionals and facilities with expertise in the care of children within a reasonable distance of their residence. Payment methodologies should be structured to guarantee the economic viability of the pediatric medical home and of pediatric specialty and subspecialty practices. The recent increase in child uninsurance over the last several years is a threat to the well-being of children and families in the short- and long-term. Deficiencies in plans currently covering insured children pose similar threats. The AAP believes that the United States must not sacrifice recent hard-won gains for our children and that child health care financing should be based on the following guiding principles: (1) coverage with quality, affordable health insurance should be universal; (2) comprehensive pediatric services should be covered; (3) cost sharing should be affordable and should not negatively affect care; (4) payment should be adequate to strengthen family- and patient-centered medical homes; (5) child health financing policy should promote equity and address longstanding health and health care disparities; and (6) the unique characteristics and needs of children should be reflected.
Collapse
Affiliation(s)
- Alison A Galbraith
- Department of Pediatrics, Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Jonathan Price
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Claire Abraham
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Angelo P Giardino
- Department of Pediatrics, University of Utah School of Medicine, Intermountain Primary Children's Hospital, Salt Lake City, Utah
| |
Collapse
|
2
|
de Oliveira Ascef B, Almeida MO, de Medeiros-Ribeiro AC, de Oliveira Andrade DC, de Oliveira Junior HA, de Soárez PC. Impact of switching between reference biologics and biosimilars of tumour necrosis factor inhibitors for rheumatoid arthritis: a systematic review and network meta-analysis. Sci Rep 2023; 13:13699. [PMID: 37607959 PMCID: PMC10444768 DOI: 10.1038/s41598-023-40222-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
What is the impact of switching between biologics and biosimilars of adalimumab, etanercept, and infliximab on efficacy and safety for rheumatoid arthritis? A systematic review and network meta-analysis were performed to compare switching and non-switching groups of treatments. Pooled Risk Relative (RR) or standardised mean differences (SMD) with 95% credible intervals (95% CrIs) were obtained. Seventeen randomized trials with a switching phase involving 6,562 patients were included. Results showed that a single switch from biologics to biosimilars compared to continuing biologics had comparable effects for primary and co-primary outcomes, the American College of Rheumatology criteria with 20% response (ACR20) (7 trials, 1,926 patients, RR 0.98, 95% CrIs 0.93 to 1.03) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) (5 trials, 1,609 patients, SMD - 0.07, 95% CrIs - 0.23 to 0.1), and within the equivalence margins: ACR20 [RR 0.94, 1.06] and HAQ-DI [SMD - 0.22, 0.22]. The risk of treatment-emergent adverse events, discontinuation, and positive anti-drug antibodies were comparable after switching. Safety results were imprecise, and the follow-up period might not be sufficient to evaluate long-term effects, especially malignancies. Overall, the practice of single switching between approved biologics and biosimilars of Tumour Necrosis Factor inhibitors is efficacious and safe for rheumatoid arthritis.
Collapse
Affiliation(s)
- Bruna de Oliveira Ascef
- Departamento de Medicina Preventiva, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455 - 2º andar - sala 2214, São Paulo, SP, 01246-903, Brazil.
| | | | - Ana Cristina de Medeiros-Ribeiro
- Disciplina de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
| | | | | | - Patrícia Coelho de Soárez
- Departamento de Medicina Preventiva, Faculdade de Medicina - FMUSP, Universidade de Sao Paulo, São Paulo, SP, Brazil
| |
Collapse
|
3
|
Sarlós P, Bikar A, Farkas N, Resál T, Szepes Z, Farkas K, Nagy F, Vincze Á, Miheller P, Molnár T. Self-reported efficacy and safety of infliximab and adalimumab biosimilars after non-medical switch in patients with inflammatory bowel disease: results of a multicenter survey. Expert Opin Biol Ther 2023; 23:827-832. [PMID: 37161387 DOI: 10.1080/14712598.2023.2211204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 05/03/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Few data are available on subjective disease control and perception of adverse events (AEs) during switching from original anti-TNF agents to biosimilars. RESEARCH DESIGN AND METHODS Hungarian patients with inflammatory bowel disease were interviewed after a mandatory non-medical switch from an infliximab (IFX) originator to a biosimilar GP1111 or from an adalimumab (ADA) originator to a biosimilar GP2017. Drug choice was based on patient's and physician's decision. Subjective efficacy was measured using a 10-point scale, and AEs were assessed. Difference in efficacy before and after the switch was compared within and between the drugs. RESULTS Seventy-three ADA and 106 IFX switching patients were interviewed. Subjective efficacy of IFX biosimilar was rated lower compared to IFX originator (8.72 ± 1.68 vs. 7.77 ± 2.34; p = 0.001). The ADA biosimilar was rated higher than its originator (9.02 ± 1.61 vs. 8.42 ± 1.93; p = 0.017). Patients receiving ADA biosimilar were more satisfied with the new treatment compared to IFX (p = 0.032). The incidence of new AEs was 85% in the ADA and 55% in the IFX group (1.79 vs. 0.93 AEs per patient, respectively, p < 0.001). CONCLUSION Subjective efficacy of switching to a biosimilar was proven in case of ADA, while reduced efficacy was experienced with IFX biosimilar. Perception of AEs was high and varied between biosimilars.
Collapse
Affiliation(s)
- Patrícia Sarlós
- Department of Medicine, University of Pecs Medical School, Pecs, Hungary
- Institute for Translational Medicine, University of Pecs Medical School, Pecs, Hungary
| | - Alexander Bikar
- Department of Medicine, University of Pecs Medical School, Pecs, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, University of Pecs Medical School, Pecs, Hungary
| | - Tamás Resál
- Department of Medicine, University of Szeged Albert Szent-Györgyi, Szeged, Hungary
| | - Zoltán Szepes
- Department of Medicine, University of Szeged Albert Szent-Györgyi, Szeged, Hungary
| | - Klaudia Farkas
- Department of Medicine, University of Szeged Albert Szent-Györgyi, Szeged, Hungary
| | - Ferenc Nagy
- Department of Medicine, University of Szeged Albert Szent-Györgyi, Szeged, Hungary
| | - Áron Vincze
- Department of Medicine, University of Pecs Medical School, Pecs, Hungary
| | - Pal Miheller
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Tamás Molnár
- Department of Medicine, University of Szeged Albert Szent-Györgyi, Szeged, Hungary
| |
Collapse
|
4
|
Schackmann L, Heringa M, Wolters M, Faber A, van Dijk L, Koster ES, Vervloet M. Facilitating pharmacy staff's conversations about non-medical medication switches: Development and testing of a communication training. Res Social Adm Pharm 2023; 19:738-745. [PMID: 36740526 DOI: 10.1016/j.sapharm.2023.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Non-medical medication switches, a change to another medicine or medication label not motivated by medical reasons, occur frequently. Switches often lead to negative patient emotions, such as confusion and anger. Pharmacy staff's communication, i.e. delivering the message and addressing patients' emotions is crucial, but experienced as difficult. OBJECTIVE To develop and test a communication training for the pharmacy team to facilitate medication switch conversations. METHODS A communication training was developed based on the 'breaking bad news model' and 'positive message framing' strategies, and incorporating needs and preferences from practice. The training consisted of an e-learning with theory and reflective exercises, a half-day live training session, and an online reflection session. The Kirkpatrick training evaluation model (levels one 'reaction' and two 'learning') was used to evaluate the training. Quantitative data were analyzed using descriptive statistics and interview data was transcribed verbatim and analyzed thematically. RESULTS Twelve pharmacists and 27 pharmacy technicians from 15 Dutch pharmacies participated in the training. According to Kirkpatrick's model level one, the major learning outcome was to give space to patients to express their emotions and/or concerns (e.g. more silences in the conversations). For level two, most participants valued practicing the conversations, role-playing, and receiving feedback. The majority of the participants indicated that they had sufficient tools and practice during the live training to apply the strategies in daily practice. A few participants still needed time and practice, or missed examples to apply the strategies. CONCLUSION The communication training based on the two strategies was well-received and participants felt well-equipped post-training. The take-away for participants was to give space to patients to express their emotions. Using these strategies and skills, pharmacy teams can tailor their medication counseling to patients' emotions and concerns during non-medical medication switches to better support patients in proper medication use.
Collapse
Affiliation(s)
- Laura Schackmann
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands; Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology & -Economics, University of Groningen, the Netherlands.
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands
| | - Majanne Wolters
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Adrianne Faber
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands; Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology & -Economics, University of Groningen, the Netherlands
| | - Ellen S Koster
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Marcia Vervloet
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| |
Collapse
|
5
|
Gilkey MB, Cripps LA, Przywara KM, Batista MI, Galbraith AA. Strategies commercially-insured families use to manage the cost of asthma care: a qualitative interview study. J Asthma 2023; 60:96-104. [PMID: 35037558 DOI: 10.1080/02770903.2022.2030749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Families affected by asthma report difficulty adhering to care regimens because of high medication costs, coupled with increased cost sharing required by some insurance plans. To inform efforts to support adherence, we conducted a qualitative study to explore how families manage asthma care costs. METHODS We conducted phone interviews with commercially-insured, US adults (n = 59) who had asthma and/or a child with asthma. Our purposive sample included participants with high- and low/no-deductible health plans. We analyzed data using thematic content analysis to identify strategies for managing asthma care costs and to assess strategies' implications for adherence. RESULTS Our analysis identified four overarching strategies for managing asthma care costs. First, participants used prevention strategies to avoid costly acute care by minimizing exposure to asthma triggers and adhering strictly to preventive medication regimens. Second, participants used shopping strategies to reduce costs, including by comparing medication prices across pharmacies, using medication coupons or free samples, and switching to lower-cost medications. Third, budgeting strategies involved putting aside funds, including in tax-exempt health savings accounts, or taking on debt to pay for care. Finally, some participants sought to reduce costs by forgoing recommended care, including by skipping medication doses or replacing prescribed medications with alternative therapies. CONCLUSION Commercially-insured families use a wide range of strategies to manage asthma care costs, with both positive and negative implications for adherence. Our typology of asthma cost management strategies can inform insurance redesign and other interventions to help families safely reduce costs and maximize adherence to recommended care.
Collapse
Affiliation(s)
- Melissa B Gilkey
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Lauren A Cripps
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | | | - Mikaela I Batista
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Alison A Galbraith
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
6
|
Patel PV, Purvis CG, Hamid RN, Feldman SR. Non-Medical Switching in Dermatology: Cost-Conscious Policy or an Affront to Patient Safety? J DERMATOL TREAT 2022; 33:2707-2710. [PMID: 35924458 DOI: 10.1080/09546634.2022.2110360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Non-medical switching is when a patient's therapy is switched for reasons unrelated to health outcomes. Dermatologists are regularly affected by non-medical switching, as many of their complex patients are on expensive medications, which become first-line targets for cost-containment. This commentary examines the literature on non-medical switching and explores the push and pull factors used to drive medication regimen changes. The system-level cost savings of this practice are substantial and could be used to fund treatment for more vulnerable patients. While there is no substantiated evidence of worse outcomes post-switching, patients may suffer negative psychosocial consequences. Negative patient expectations, which are in part fueled by prescriber suspicion of non-medical switching, seem to contribute to this effect. While non-medical switching is not ideal for all patients, it has the potential to reduce cost while maintaining patient outcomes. The decision to switch should be made only after careful evaluation of the individual patient and their physical and psychological reserve.
Collapse
Affiliation(s)
- Palak V Patel
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caitlin G Purvis
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ramiz N Hamid
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston- Salem, North Carolina.,Department of Dermatology, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
7
|
Liu Y, Skup M, Yang M, Qi CZ, Wu EQ. Discontinuation and Switchback After Non-Medical Switching from Originator Tumor Necrosis Factor Alpha (TNF) Inhibitors to Biosimilars: A Meta-Analysis of Real-World Studies from 2012 to 2018. Adv Ther 2022; 39:3711-3734. [PMID: 35737227 PMCID: PMC9309144 DOI: 10.1007/s12325-022-02173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/26/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION To examine the prevalence rates of biosimilar discontinuation and switchback to the originator tumor necrosis factor alpha (TNF) inhibitors following non-medical switch (NMS) in patients. METHODS Real-world studies reporting biosimilar discontinuation and switchback rates following NMS published between January 2012 and August 2018 were identified through a systematic literature review. A meta-analysis estimated the annualized discontinuation and switchback rates. A subsequent meta-analysis assessed annualized incremental discontinuation rate among studies reporting both discontinuation rates in patients who underwent an NMS (switchers) and patients who remained on originators (non-switchers). RESULTS A total of 66 publications were identified: 31 in gastroenterology, 32 in rheumatology, and 3 in both. Half of the studies reported switchback rates; only 9 studies reported discontinuation rates for both switchers and non-switchers. Across studies, the mean/range sample size of the NMS patient population was 136/9-1641; mean/range follow-up was 10/3-24 months. Annualized biosimilar discontinuation rate was 21% (95% confidence interval [CI] 18%, 25%). Switchback rate was 14% (95% CI 10%, 17%) among all NMS patients and 62% (95% CI 44%, 80%) among discontinuers. The mean/range sample size of switchers and non-switchers was 344/89-1621 and 768/19-2870, respectively; mean/range follow-up was 11/6-18 and 12/6-8 months, respectively. Annualized incremental biosimilar discontinuation rate was 18% (95% CI 4%, 31%). CONCLUSION Biosimilar discontinuation was found to be prevalent among patients who underwent an NMS from an originator TNF inhibitor to its biosimilar(s) in the real world. In addition, switchback to the originator TNF inhibitors was common following biosimilar discontinuation. Careful consideration is necessary when switching patients already on an originator TNF inhibitor to its biosimilar(s). Main limitations included the heterogeneity of the studies and the limited comparability of the data.
Collapse
Affiliation(s)
- Yifei Liu
- University of Missouri-Kansas City School of Pharmacy, 1228 Health Sciences Building, 2464 Charlotte Street, Kansas City, MO, 64108, USA.
| | | | - Min Yang
- Analysis Group, Inc., Boston, MA, USA
| | | | - Eric Q Wu
- Analysis Group, Inc., Boston, MA, USA
| |
Collapse
|
8
|
Park KH, Tickle L, Cutler H. A systematic review and meta-analysis on impact of suboptimal use of antidepressants, bisphosphonates, and statins on healthcare resource utilisation and healthcare cost. PLoS One 2022; 17:e0269836. [PMID: 35767543 PMCID: PMC9242484 DOI: 10.1371/journal.pone.0269836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/28/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Depression, osteoporosis, and cardiovascular disease impose a heavy economic burden on society. Understanding economic impacts of suboptimal use of medication due to nonadherence and non-persistence (non-MAP) for these conditions is important for clinical practice and health policy-making. OBJECTIVE This systematic literature review aims to assess the impact of non-MAP to antidepressants, bisphosphonates and statins on healthcare resource utilisation and healthcare cost (HRUHC), and to assess how these impacts differ across medication classes. METHODS A systematic literature review and an aggregate meta-analysis were performed. Using the search protocol developed, PubMed, Cochrane Library, ClinicalTrials.gov, JSTOR and EconLit were searched for articles that explored the relationship between non-MAP and HRUHC (i.e., use of hospital, visit to healthcare service providers other than hospital, and healthcare cost components including medical cost and pharmacy cost) published from November 2004 to April 2021. Inverse-variance meta-analysis was used to assess the relationship between non-MAP and HRUHC when reported for at least two different populations. RESULTS Screening 1,123 articles left 10, seven and 13 articles on antidepressants, bisphosphonates, and statins, respectively. Of those, 27 were rated of good quality, three fair and none poor using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. In general, non-MAP was positively associated with HRUHC for all three medication classes and most prominently for bisphosphonates, although the relationships differed across HRUHC components and medication classes. The meta-analysis found that non-MAP was associated with increased hospital cost (26%, p = 0.02), outpatient cost (10%, p = 0.01), and total medical cost excluding pharmacy cost (12%, p<0.00001) for antidepressants, and increased total healthcare cost (3%, p = 0.07) for bisphosphonates. CONCLUSIONS This systematic literature review is the first to compare the impact of non-MAP on HRUHC across medications for three prevalent conditions, depression, osteoporosis and cardiovascular disease. Positive relationships between non-MAP and HRUHC highlight inefficiencies within the healthcare system related to non-MAP, suggesting a need to reduce non-MAP in a cost-effective way.
Collapse
Affiliation(s)
- Kyu Hyung Park
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Leonie Tickle
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
| | - Henry Cutler
- Macquarie Business School, Macquarie University, North Ryde, New South Wales, Australia
- Macquarie University Centre for the Health Economy, North Ryde, Australia
| |
Collapse
|
9
|
Dipasquale V, Cucinotta U, Romano C. Biosimilars in Pediatric IBD: Updated Considerations for Disease Management. Biologics 2022; 16:57-66. [PMID: 35721798 PMCID: PMC9205321 DOI: 10.2147/btt.s367032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/03/2022] [Indexed: 11/23/2022]
Abstract
Biologic drugs have significantly modified the pharmacological management of several chronic conditions, including inflammatory bowel diseases (IBD). By contrast, in the last two decades, biologics have been associated with increased direct medical costs. As patents for the reference drugs have expired, the development and commercialization of biosimilars through abbreviated licensing pathways represented an affordable alternative in patients fulfilling the indication for biologics. A growing body of evidence, first in adults and then in the pediatric age group too, has provided reassuring data in terms of efficacy and safety of biosimilars both in naïve patients and in those previously on reference drugs who had to switch to the biosimilar. This review summarizes the currently available evidence for biosimilar use in IBD, with a focus on pediatric IBD. The most common practical approaches to biosimilar use in the pediatric clinical settings are also discussed.
Collapse
Affiliation(s)
- Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
- Correspondence: Valeria Dipasquale, Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Via Consolare Valeria 1, Messina, 98124, Italy, Tel +390902212918, Email
| | - Ugo Cucinotta
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| |
Collapse
|
10
|
Addressing Autoimmune and Immune-mediated Skin Disease Burden in Women. Womens Health Issues 2022; 32:322-326. [PMID: 35300917 DOI: 10.1016/j.whi.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/23/2022]
|
11
|
Stavem K. Switching from one reference biological to another in stable patients for non-medical reasons: a literature search and brief review. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2021; 9:1964792. [PMID: 34434534 PMCID: PMC8381978 DOI: 10.1080/20016689.2021.1964792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/02/2021] [Accepted: 08/02/2021] [Indexed: 05/25/2023]
Abstract
Background: The practice of non-medical switch (NMS) from a reference biological (originator) to a biosimilar is widely accepted in some countries. However, there is little documentation on the impact of NMS from one originator to another originator. Objectives: To assess the consequences for patients of NMS from one biological originator to another, based on existing literature. The focus was on efficacy and cost of treatment with TNF-α-inhibitors in three disease areas. Methods: A literature search was conducted in Ovid (PubMed, EMBASE) and abstracts from meetings in key therapeutic areas, to identify studies reporting efficacy, safety or costs by switching between originator biologics. Results: 167 references were identified and abstracts screened; 36 papers reviewed in full text, and 6 fulfilled the inclusion criteria. Three clinical studies of NMS had very small sample sizes, but suggested that NMS is beneficial. The remaining three studies used administrative data with little clinical information, indicating that NMS was disadvantageous and associated with increased health care utilization and costs. Conclusions: There is very limited documentation on NMS from one originator biological to another, and the literature suffers from methodological limitations. The results are mixed and preclude drawing an overriding conclusion. Future studies, are warranted.
Collapse
Affiliation(s)
- Knut Stavem
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
12
|
Bickel S, Morton R, O'Hagan A, Canal C, Sayat J, Eid N. Impact of Payor-Initiated Switching of Inhaled Corticosteroids on Lung Function. J Pediatr 2021; 234:128-133.e1. [PMID: 33711287 DOI: 10.1016/j.jpeds.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the impact of a payor-initiated formulary change in inhaled corticosteroid coverage on lung function in patients with asthma and on provider prescribing practices. This formulary change, undertaken in August 2016 by a Medicaid payor in Kentucky, eliminated coverage of beclomethasone dipropionate, a metered dose inhaler (MDI), in favor of mometasone furoate, available as MDI and dry powder inhaler (DPI). STUDY DESIGN A retrospective chart review was conducted on children with asthma ages 6-18 years covered by the relevant payor from a university-based pediatric practice who were seen before the formulary change (February to July 2016) and after (February to July 2017). Spirometry data from each visit was compared using the paired Student t test. RESULTS Fifty-eight patients were identified who were initially on beclomethasone dipropionate and had spirometry available at both visits. Those who switched from an MDI to a DPI (n = 24) saw a decline in median predicted forced expiratory volume in 1 second from 98.5% to 91% (P = .013). A decline was also seen in forced expiratory flow at 25%-75%, from 89.5% predicted to 76% predicted (P = .041). No significant changes were observed in children remaining on an MDI. Seven patients discontinued inhaled corticosteroid therapy. CONCLUSIONS This study suggests insurance formulary changes leading to use of a different inhaler device may have a detrimental impact on pediatric lung function, which may be a surrogate measure for overall asthma control. This could be due to a lack of adequate timely educational intervention as well as the inability of some children to use DPIs.
Collapse
Affiliation(s)
- Scott Bickel
- Division of Pediatric Pulmonology, Norton Children's and University of Louisville School of Medicine, Louisville, KY.
| | - Ronald Morton
- Division of Pediatric Pulmonology, Norton Children's and University of Louisville School of Medicine, Louisville, KY
| | - Adrian O'Hagan
- Division of Pediatric Pulmonology, Norton Children's and University of Louisville School of Medicine, Louisville, KY
| | - Caitlin Canal
- Department of Pediatrics, Witham Health Services, Lebanon, IN
| | - Jonathan Sayat
- Division of General Pediatrics, Norton Children's and University of Louisville School of Medicine, Louisville, KY
| | - Nemr Eid
- Division of Pediatric Pulmonology, Norton Children's and University of Louisville School of Medicine, Louisville, KY
| |
Collapse
|
13
|
Panaccione R. The Great Debate With IBD Biosimilars: Con: Biosimilars Should Not Be Routinely Used as a First Line Biologic and Not Switched From Reference Biologics. CROHN'S & COLITIS 360 2021; 3:otab038. [PMID: 36776671 PMCID: PMC9802193 DOI: 10.1093/crocol/otab038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Indexed: 12/25/2022] Open
Abstract
The costs associated with biologic therapy in immune-mediated diseases, including inflammatory bowel disease has steadily increased since their introduction over 2 decades ago. The introduction of biosimilars has the promise of cost savings and putting reimbursement pressure on future market entries. However, the interpretation of evidence to support the use of biosimilars either as first line or as part of a nonmedical switch strategy is not straight forward due to low to very low-quality evidence. In particular, switching to a biosimilar is associated with both clinical, ethical, and possibly medicolegal issues. Due to these factors, solutions to address cost efficiency should involve an open, transparent, and collaborative dialogue among the various stakeholders and if at all possible involve strategies that allow patients to remain on originator biologics.
Collapse
Affiliation(s)
- Remo Panaccione
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Address correspondence to: Remo Panaccione, MD, FRCPC, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada ()
| |
Collapse
|
14
|
Gembillo G, Ingrasciotta Y, Crisafulli S, Luxi N, Siligato R, Santoro D, Trifirò G. Kidney Disease in Diabetic Patients: From Pathophysiology to Pharmacological Aspects with a Focus on Therapeutic Inertia. Int J Mol Sci 2021; 22:4824. [PMID: 34062938 PMCID: PMC8124790 DOI: 10.3390/ijms22094824] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/11/2022] Open
Abstract
Diabetes mellitus represents a growing concern, both for public economy and global health. In fact, it can lead to insidious macrovascular and microvascular complications, impacting negatively on patients' quality of life. Diabetic patients often present diabetic kidney disease (DKD), a burdensome complication that can be silent for years. The average time of onset of kidney impairment in diabetic patients is about 7-10 years. The clinical impact of DKD is dangerous not only for the risk of progression to end-stage renal disease and therefore to renal replacement therapies, but also because of the associated increase in cardiovascular events. An early recognition of risk factors for DKD progression can be decisive in decreasing morbidity and mortality. DKD presents patient-related, clinician-related, and system-related issues. All these problems are translated into therapeutic inertia, which is defined as the failure to initiate or intensify therapy on time according to evidence-based clinical guidelines. Therapeutic inertia can be resolved by a multidisciplinary pool of healthcare experts. The timing of intensification of treatment, the transition to the best therapy, and dietetic strategies must be provided by a multidisciplinary team, driving the patients to the glycemic target and delaying or overcoming DKD-related complications. A timely nephrological evaluation can also guarantee adequate information to choose the right renal replacement therapy at the right time in case of renal impairment progression.
Collapse
Affiliation(s)
- Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (R.S.)
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (Y.I.); (S.C.)
| | - Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (Y.I.); (S.C.)
| | - Salvatore Crisafulli
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98125 Messina, Italy; (Y.I.); (S.C.)
| | - Nicoletta Luxi
- Department of Diagnostics and Public Health, University of Verona, 37100 Verona, Italy; (N.L.); (G.T.)
| | - Rossella Siligato
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (R.S.)
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy; (G.G.); (R.S.)
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, 37100 Verona, Italy; (N.L.); (G.T.)
| |
Collapse
|
15
|
Raine T, Gkini MA, Irving PM, Kaul A, Korendowych E, Laws P, Foulkes AC. Maintaining Clinical Freedom Whilst Achieving Value in Biologics Prescribing: An Integrated Cross-Specialty Consensus of UK Dermatologists, Rheumatologists and Gastroenterologists. BioDrugs 2021; 35:187-199. [PMID: 33635522 PMCID: PMC7952361 DOI: 10.1007/s40259-020-00464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND Biologics are now key drugs in the management of immune-mediated inflammatory diseases. However, the increasingly complex biologics environment and growing cost pressures in the UK have led to variability in drug commissioning and inequity of patient access across regions. OBJECTIVES Our objectives were to provide consensus recommendations for enhancing the current situation in biologic prescribing in the UK by balancing clinical freedom with equitable distribution of biologics given the limited availability of resources. METHODS A modified Delphi approach was used to reach integrated, cross-specialty consensus among dermatologists, rheumatologists and gastroenterologists practising within the English National Health Service (NHS). RESULTS We describe the concepts of clinical freedom and clinical judgement and demonstrate how, together with patient choice, they can be exercised in the context of biologic prescribing in the NHS. We highlight that in England, local variations occur that are at odds with National Institute for Health and Care Excellence (NICE) guidance; these variably limit the degree to which clinicians can exercise clinical freedom and impact on equity of patient access to treatments. We define factors encompassing a drug's value and identify challenges to the measurement and interpretation of this concept, which can raise barriers to the freedom of clinical choice and appropriate prescribing decisions allowing practices of holistic and personalised medicine. Cross-specialty consensus recommendations on ensuring equitable access to biologics in the NHS while protecting appropriate and individualised drug selection for patients are provided. We have also provided strategies for improving physician-commissioner communication to harmonise equity of patient access to biologics across England and improve patient outcomes. Commentary from patient advisory groups indicates that they welcome our exploration that value does not equal cost and agree that there should be an emphasis on shared decision making, which requires the clinician to practice clinical freedom by aligning the patient's needs and preferences with available treatment choices. CONCLUSIONS This consensus highlights the need to strike a balance between clinical freedom and short-term cost restrictions to support equitable resource distribution within the English NHS. Consideration of these recommendations may help to harmonise local, regional and national services and balance equity of patient access to biologic treatments with excellence in the NHS.
Collapse
Affiliation(s)
- Tim Raine
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | | | - Peter M Irving
- IBD Centre, Department of Gastroenterology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Arvind Kaul
- Centre for Rheumatology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Eleanor Korendowych
- Department of Rheumatology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Philip Laws
- Department of Dermatology, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Amy C Foulkes
- The Dermatology Centre, Salford Royal NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
16
|
Krstic M, Devaud JCA, Sadeghipour F. Pharmacists' considerations on non-medical switching at the hospital: a systematic review of the economic outcomes of cost-saving therapeutic drug classes. Eur J Hosp Pharm 2021; 28:e2-e7. [PMID: 33472819 DOI: 10.1136/ejhpharm-2020-002652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Non-medical switching (NMS) strategies have the capacity to reduce overall costs in hospitals while maintaining a high level of care. However, the most appropriate diseases and/or medicines for NMS strategies are still vague. The aim of this review was to give a state-of-the-art summary regarding the economic outcomes resulting from the use of NMS strategies and to discuss whether they would be implementable in a hospital inpatient setting. METHODS A systematic literature search was conducted in Medline, Embase, and ScienceDirect. Studies published between 1988 and 2018 were included if they evaluated the economic impact of NMS strategies or if they performed an economic evaluation between two drugs. Studies regarding antineoplastic agents, endocrine therapies, and immunostimulants, or immunosuppressants, and biosimilars were excluded. RESULTS Fifty (69%) studies assessing an NMS strategy and 22 (31%) studies comparing two medicines were allocated to four categories: prospective studies (n=8, 11%); retrospective chart reviews (n=29, 40%); retrospective claims analysis (n=13, 18%); and retrospective data analysis (n=22, 31%). Hypercholesterolemia, peptic ulcer, and gastro-oesophageal reflux diseases, diabetes mellitus, and venous thromboembolism were the most prevalent diseases in studies evaluating an NMS strategy. Sixty-eight per cent of the included papers reported a reduction in costs with no significant changes in health outcomes and 8 per cent reported a deterioration in health outcomes and/or increased costs. CONCLUSION Regardless of the exclusion of studies regarding biologics or medicines used in oncology, the review highlights that NMS strategies with medicines whose management do not require a thorough clinical assessment were associated with reduced costs and no significant changes in patients' health outcomes, in the inpatient setting. NMS strategies targeting medicines that require an extensive clinical assessment should be evaluated using hospital-specific effectiveness and/or utility data prior to their implementation.
Collapse
Affiliation(s)
- Marko Krstic
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva Faculty of Science, Geneva, Switzerland .,Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Farshid Sadeghipour
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva Faculty of Science, Geneva, Switzerland.,Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
17
|
Arfken CL, Tutag Lehr V. Commercial and public payer opioid analgesic prescribing policies: a case study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:4. [PMID: 33407646 PMCID: PMC7789815 DOI: 10.1186/s13011-020-00340-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/03/2022]
Abstract
Background One strategy to address the high number of U.S. opioid-related deaths is to restrict high-risk or inappropriate opioid analgesic prescribing and dispensing. Federal and state laws and regulations have implemented restrictions but less is known about commercial and public payers’ policies aside from clinician anecdotal reports that these policies are increasing. To assess the number and types of policies with temporal trends, we examined commercial and public (Medicaid) payer policies in one state, Michigan, that has high opioid-related deaths and implemented opioid analgesic prescribing laws. Methods Policies for seven large commercial payers and the public payer for 2012–2018 were reviewed and categorized by actions. Joinpoint regression was used to summarize temporal trends on number of policies for all payers and subgroups. Results Across the 7 years, there were 529 action policies (75.57 (95% confidence intervals (CI) 35.93, 115.22) actions per year) with a range of 36 to 103 actions by payer. Limitations on number of days for initial prescriptions and prior authorizations were the most frequently implemented policy. The temporal trend showed a decline in new policies from 2012 to 2013 but a steady increase from 2014 to 2018 (average annual percent change or AAPC=29.6% (95% confidence intervals 13.2, 48.5%)). The public payer (n=47 policies) showed no increase in number of policies over time (AAPC=2.9% (95% CI -41.6, 61.6%). Conclusions The eight commercial and public payers implemented many new policies to restrict opioid analgesic prescribing with a steady increase in the number of such policies implemented from 2014 to 2018. This case study documented that at least in one state with high opioid-related deaths and multiple commercial payers, new and different policies were increasingly implemented creating barriers to patient care. The impact of these policies is understudied, complicating recommendation of best practices.
Collapse
Affiliation(s)
- Cynthia L Arfken
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, 3901 Chrysler Drive, Suite 1B, Detroit, MI, 48201, USA
| | - Victoria Tutag Lehr
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, 259 Mack Avenue, Room 4144, Detroit, MI, 48201, USA.
| |
Collapse
|
18
|
Talathi S, Baig KRKK. Biosimilars in inflammatory bowel disease. J Dig Dis 2020; 21:610-620. [PMID: 32920972 DOI: 10.1111/1751-2980.12940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/11/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022]
Abstract
The advent of biologics has changed outcomes in many chronic conditions, including inflammatory bowel disease (IBD). Biologics have been used for the induction and remission of ulcerative colitis and Crohn's disease for almost two decades and are effective in patients who used to fail conventional treatment with steroids, immunomodulators. The use of biologics in the treatment of IBD has increased over the last few years, partly due to the rise in its incidence and the use of biologics as a first-line treatment in severe disease as well as in complicated diseases like penetrating/fistulating Crohn's disease. However, their use is associated with a significant burden to the society with respect to healthcare costs, resulting in the premature discontinuation of therapy in some patients, leading to exacerbations and complications. The introduction of biosimilars a decade ago seems to be a promising approach to reducing the costs related to therapy. Since their introduction, numerous studies conducted in adults and some in children show the efficacy of biosimilars with a similar side-effect profile to biologics. This review discusses the history of biosimilars in the treatment of IBD, enumerates several such studies and discusses the possibility of using biosimilars in the future.
Collapse
Affiliation(s)
- Saurabh Talathi
- Department of Pediatrics, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | | |
Collapse
|
19
|
Haifer C, Srinivasan A, An YK, Picardo S, van Langenberg D, Menon S, Begun J, Ghaly S, Thin L. Switching Australian patients with moderate to severe inflammatory bowel disease from originator to biosimilar infliximab: a multicentre, parallel cohort study. Med J Aust 2020; 214:128-133. [PMID: 33070332 DOI: 10.5694/mja2.50824] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To examine whether non-medical switching of patients with inflammatory bowel disease (IBD) from originator infliximab to a biosimilar (CT-P13, Inflectra) is safe and clinically non-inferior to continued treatment with originator infliximab. DESIGN Prospective, open label, multicentre, parallel cohort, non-inferiority study in seven Australian hospitals over 48 weeks, May 2017 - October 2019. PARTICIPANTS Adults (18 years or older) with IBD receiving maintenance originator infliximab (Remicade) who had been in steroid-free clinical remission for at least 12 weeks. INTERVENTION Managed program for switching patients in four hospitals from originator to biosimilar infliximab (CT-P13); patients in three other hospitals continued to receive originator infliximab (control). MAIN OUTCOME MEASURES Clinical disease worsening requiring infliximab dose escalation or change in therapy. RESULTS The switch group included 204 patients, the control group 141 patients with IBD. Ten patients in the control group (7%) and 16 patients switched to CT-P13 (8%) experienced clinical deterioration; the adjusted risk difference (control v switch group) was -1.1 percentage points (95% CI, -6.1 to 8.2 percentage points), within our pre-specified non-inferiority margin of 15 percentage points. Serious adverse events leading to infliximab discontinuation were infrequent in both the switch (six, 3%) and control (six, 4%) groups. CONCLUSION Switching patients with IBD from originator to biosimilar infliximab is safe and non-inferior to continuing treatment with originator infliximab. Moreover, the introduction of biosimilar infliximab, by increasing market competition, has resulted in substantial cost savings for the Pharmaceutical Benefits Scheme.
Collapse
Affiliation(s)
- Craig Haifer
- St Vincent's Hospital Sydney, Sydney, NSW.,The University of Sydney, Sydney, NSW
| | - Ashish Srinivasan
- Eastern Health, Melbourne, VIC.,Monash University Eastern Health Clinical School, Melbourne, VIC
| | - Yoon-Kyo An
- Mater Hospital Brisbane, Brisbane, QLD.,The University of Queensland, Brisbane, QLD
| | | | - Daniel van Langenberg
- Eastern Health, Melbourne, VIC.,Monash University Eastern Health Clinical School, Melbourne, VIC
| | | | - Jakob Begun
- Mater Hospital Brisbane, Brisbane, QLD.,Mater Research Institute, University of Queensland, Brisbane, QLD
| | - Simon Ghaly
- St Vincent's Hospital Sydney, Sydney, NSW.,St Vincent's Clinical School, University of New South Wales, Sydney, NSW
| | - Lena Thin
- Fiona Stanley Hospital, Perth, WA.,The University of Western Australia, Perth, WA
| |
Collapse
|
20
|
Coleman C, Salam T, Duhig A, Patel AA, Cameron A, Voelker J, Bookhart B. Impact of non-medical switching of prescription medications on health outcomes: an e-survey of high-volume medicare and medicaid physician providers. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2020; 8:1829883. [PMID: 33144928 PMCID: PMC7580836 DOI: 10.1080/20016689.2020.1829883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Non-medical switching refers to a change in a stable patient's prescribed medication to a clinically distinct, non-generic, alternative for reasons other than poor clinical response, side-effects or non-adherence. OBJECTIVE To assess the perceptions of high-volume Medicare and/or Medicaid physician providers regarding the impact non-medical switching has on their patients' medication-related outcomes and health-care utilization. METHODS We performed an e-survey of high-volume Medicare and/or Medicaid physicians (spending >50% of their time caring for Medicare and/or Medicaid patients), practicing for >2 years but <30 years post-residency and/or fellowship; working in a general, internal, family medicine or specialist setting; spending ≥40% of their time providing direct care and having received ≥1 request for a non-medical switch in the past 12 months. Physicians were queried on 15-items to assess perceptions regarding the impact non-medical switching on medication-related outcomes and health-care utilization. RESULTS Three-hundred and fifty physicians were included. Respondents reported they felt non-medical switching, to some degree, increased side-effects (54.0%), medication errors (56.0%) and medication abandonment (60.3%), and ~50% believed it increased patients' out-of-pocket costs. Few physicians (≤13.4% for each) felt non-medical switching had a positive impact on effectiveness, adherence or patients' or physicians' confidence in the quality-of-care provided. Non-office visit and prescriber-pharmacy contact were most frequently thought to increase due to non-medical switching. One-third of physicians felt office visits were very frequently/frequently increased, and ~ 1-in-5 respondents believed laboratory testing and additional medication use very frequently/frequently increased following a non-medical switch. About 1-in-10 physicians felt non-medical switching very frequently/frequently increased the utilization of emergency department or in-hospital care. CONCLUSION This study suggests high-volume Medicare and/or Medicaid physician providers perceive multiple negative influences of non-medical switching on medication-related outcomes and health-care utilization.
Collapse
Affiliation(s)
- Craig Coleman
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
- Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, USA
| | - Tabassum Salam
- Medical Education, American College of Physicians, Philadelphia, PA, USA
| | - Amy Duhig
- Consulting Services, Xcenda, Palm Harbor, FL, USA
| | - Aarti A. Patel
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, Titusville, USA
| | - Ann Cameron
- Consulting Services, Xcenda, Palm Harbor, FL, USA
| | - Jennifer Voelker
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, Titusville, USA
| | - Brahim Bookhart
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, Titusville, USA
| |
Collapse
|
21
|
Kaplan GG, Ma C, Seow CH, Kroeker KI, Panaccione R. The Argument Against a Biosimilar Switch Policy for Infliximab in Patients with Inflammatory Bowel Disease Living in Alberta. J Can Assoc Gastroenterol 2020; 3:234-242. [PMID: 32905124 PMCID: PMC7465546 DOI: 10.1093/jcag/gwz044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
A nonmedical switch policy is currently being considered in Alberta, which would force patients on originator biologics to biosimilar alternatives with the hypothetical aim of reducing costs to the health care system. The evidence to support the safety of nonmedical switching in patients with inflammatory bowel disease (IBD) is of low to very low quality; in fact, existing data suggest a potential risk of harm. In a pooled analysis of randomized controlled trials, one patient would lose response to infliximab for every 11 patients undergoing nonmedical switching. Switching to a biosimilar has important logistical and ethical implications including potential forced treatment changes without appropriate patient consent and unfairly penalizing patients living in rural areas and those without private drug insurance. Even in the best-case scenario, assuming perfectly executed switching without logistical delays, we predict switching 2,000 patients with Remicade will lead to over 60 avoidable surgeries in Alberta. Furthermore, nonmedical switching has not been adequately studied in vulnerable populations such as children, pregnant women, and elderly patients. While the crux of the argument for nonmedical switching is cost savings, biosimilar switching may not be cost effective: Particularly when originator therapies are being offered at the same price as biosimilars. Canadian patients with IBD have been surveyed, and their response is clear: They are not in support of nonmedical switching. Policies that directly influence patient health need to consider patient perspectives. Solutions to improve cost efficiency in health care exist but open, transparent collaboration between all involved stakeholders is required.
Collapse
Affiliation(s)
- Gilaad G Kaplan
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia H Seow
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen I Kroeker
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Remo Panaccione
- Inflammatory Bowel Disease Clinic, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
22
|
Costa OS, Salam T, Duhig A, Patel AA, Cameron A, Voelker J, Bookhart B, Coleman CI. Specialist physician perspectives on non-medical switching of prescription medications. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2020; 8:1738637. [PMID: 32284826 PMCID: PMC7144249 DOI: 10.1080/20016689.2020.1738637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 05/31/2023]
Abstract
Introduction: A non-medical switch is a change to a patient's medication regimen for reasons other than lack of clinical response, side-effects or poor adherence. Specialist physicians treat complex patients who may be vulnerable to non-medical switching. Objectives: To evaluate specialist physicians' perceptions regarding the frequency of non-medical switch requests, and the impact on their patients' outcomes and healthcare utilization. Methods: An online survey of randomly sampled physicians spending ≥10% of time providing patient care and having received ≥1 non-medical switch request during the prior 12-months. Results: Among 404 specialist physicians surveyed, non-medical switch requests were reported as very frequent or frequent by 35.0% of oncologists (for injectable cancer agents) and up to 80.3% of endocrinologists (for injectable anti-hyperglycemics). Respondents reported decreased medication effectiveness (25.0% of oncologists to 75.0% of dermatologists) and increased side-effects (32.5% of oncologists to 66.7% of psychiatrists). Most specialists reported very frequent or frequent increases in non-office visits (52.5% of oncologists to 75.3% of endocrinologists) and calls with pharmacies (57.5% of oncologists to 80.5% of rheumatologists) due to non-medical switching. Conclusions: Receipt of non-medical switching requests were common among specialist physicians. Non-medical switching may lead to negative effects on patient care and require increased healthcare utilization.
Collapse
Affiliation(s)
- Olivia S. Costa
- School of Pharmacy, University of Connecticut, Storrs, CT, USA
- Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, USA
| | - Tabassum Salam
- Medical Education, American College of Physicians, Philadelphia, PA, USA
| | - Amy Duhig
- Consulting Services, Xcenda, Palm Harbor, FL, USA
| | - Aarti A. Patel
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, PA, USA
| | - Ann Cameron
- Consulting Services, Xcenda, Palm Harbor, FL, USA
| | - Jennifer Voelker
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, PA, USA
| | - Brahim Bookhart
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, PA, USA
| | - Craig I. Coleman
- School of Pharmacy, University of Connecticut, Storrs, CT, USA
- Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, USA
| |
Collapse
|
23
|
Karam SL, Dendy J, Polu S, Blonde L. Overview of Therapeutic Inertia in Diabetes: Prevalence, Causes, and Consequences. Diabetes Spectr 2020; 33:8-15. [PMID: 32116448 PMCID: PMC7026754 DOI: 10.2337/ds19-0029] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Many people with diabetes do not achieve individualized treatment targets. Therapeutic inertia, the underuse of effective therapies in preventing serious clinical end points, is a frequent, important contributor to this failure. Clinicians, patients, health systems, payors, and producers of medications, devices, and other products for those with diabetes all play a role in the development of therapeutic inertia and can all help to reduce it.
Collapse
Affiliation(s)
- Susan L Karam
- Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA
| | - Jared Dendy
- Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA
| | - Shruti Polu
- Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA
| | - Lawrence Blonde
- Frank Riddick Diabetes Institute, Department of Endocrinology, Ochsner Medical Center, New Orleans, LA
| |
Collapse
|
24
|
Moayyedi P, Benchimol EI, Armstrong D, Yuan C, Fernandes A, Leontiadis GI. Joint Canadian Association of Gastroenterology and Crohn's Colitis Canada Position Statement on Biosimilars for the Treatment of Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2020; 3:e1-e9. [PMID: 32010877 PMCID: PMC6985688 DOI: 10.1093/jcag/gwz035] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/31/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- Paul Moayyedi
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Eric I Benchimol
- Children’s Hospital of Eastern Ontario (CHEO) Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition and CHEO Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - David Armstrong
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Cathy Yuan
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Aida Fernandes
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Grigorios I Leontiadis
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
25
|
Salam T, Duhig A, Patel AA, Cameron A, Voelker J, Bookhart B, Coleman CI. Physicians' perspectives regarding non-medical switching of prescription medications: Results of an internet e-survey. PLoS One 2020; 15:e0225867. [PMID: 31923201 PMCID: PMC6953849 DOI: 10.1371/journal.pone.0225867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/13/2019] [Indexed: 11/19/2022] Open
Abstract
Background Physicians are in an ideal position to describe the impact of medication non-medical switching (switching commonly due to formulary changes by insurer for reasons unrelated to patient health) on their practice dynamics and patient care. We sought to examine physicians’ openness to requests for non-medical switching and their experiences and opinions regarding the impact of non-medical switching on their practice, staff and patients. Methods An online survey of randomly-sampled physicians spending ≥10% of time providing patient care and having received ≥1 non-medical switch request during the prior 12-months. The impact of non-medical switching on clinical decision-making process; professional experience with clinical practice, patient-physician relationship, insurance process; and perceived impact on practice, staff and patients were assessed. Weighted percent responses were calculated. Results We sampled 1,010 physicians (response rate = 55.5%). Many responded being frequently not amenable (26.0%) or had reservations (41.8%) to non-medical switch requests; with >50% indicating patient stability on current therapy and suboptimal alternatives as factors frequently influencing amenability. Physicians agreed non-medical switching can create ethical concerns (clinical judgement, autonomy, ability to treat per guidelines; 74.8%, 82.3%, 53.5%, respectively), while forcing them to take responsibility for insurers’ decisions (81.1%) and diverting their clinical time (84.3%). Most indicated non-medical switching increased practice burden (administrative, non-billable interactions, additional staffing, non-office patient contact, calls to/from the pharmacy; 85.0%, 72.5%, 62.2%, 64.2%, 69.5%, respectively). Physicians felt insurer processes discouraged non-medical switch challenges (76.7%) and required inconvenient lengths-of-time (76.1%) speaking to insurer representatives without proper expertise (62.0%). They believed non-medical switching negatively impacted aspects of care (effectiveness, side-effects, medication adherence and abandonment, out-of-pocket costs, medication errors; 46.5%, 53.2%, 50.6%, 49.4%, 59.6%, 54.5%, respectively). Conclusions Physicians were frequently not amenable or had reservations regarding non-medical switching. They noted ethical concerns due to non-medical switching. Most felt non-medical switches burdened their practice and negatively impacted care.
Collapse
Affiliation(s)
- Tabassum Salam
- Medical Education, American College of Physicians, Philadelphia, PA, United States of America
| | - Amy Duhig
- Consulting Services, Xcenda, Palm Harbor, FL, United States of America
| | - Aarti A. Patel
- Janssen Scientific Affairs, LLC, Titusville, NJ, PA, United States of America
| | - Ann Cameron
- Consulting Services, Xcenda, Palm Harbor, FL, United States of America
| | - Jennifer Voelker
- Janssen Scientific Affairs, LLC, Titusville, NJ, PA, United States of America
| | - Brahim Bookhart
- Janssen Scientific Affairs, LLC, Titusville, NJ, PA, United States of America
| | - Craig I. Coleman
- University of Connecticut School of Pharmacy, Storrs, CT, United States of America
- Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, United States of America
- * E-mail:
| |
Collapse
|
26
|
Gilbert I, Wada K, Burudpakdee C, Ghai C, Tan L. The Impact of a Forced Non-Medical Switch of Inhaled Respiratory Medication Among Patients with Asthma or Chronic Obstructive Pulmonary Disease: A Patient Survey on Experience with Switch, Therapy Satisfaction, and Disease Control. Patient Prefer Adherence 2020; 14:1463-1475. [PMID: 32903885 PMCID: PMC7445512 DOI: 10.2147/ppa.s242215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/26/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Budesonide/formoterol pressurized metered-dose inhaler (pMDI) was removed from a Medicare Part D formulary, and patients switched to fluticasone-based dry powder inhaler (DPI) therapies. This study describes the experience, satisfaction, and disease control among patients with asthma or chronic obstructive pulmonary disease (COPD) who switched due to removal from the formulary. PATIENTS AND METHODS A patient survey was conducted among adults with asthma or COPD who used budesonide/formoterol pMDI for ≥3 months prior to the formulary block and the new medication for ≥3 weeks after switching, recruited by providers in a research panel. Survey comprised both validated instruments (PASAPQ, OEQ, ACQ-6, and CAT) and stand-alone questions. Patient characteristics, switch experience, device and treatment satisfaction, onset of effect, and disease control were compared between disease (asthma and COPD) and medication (once and twice daily) cohorts. Minimal significance for group differences: P≤0.05. RESULTS Among 100 patients, 93% received communication from their doctor or nurse about the switch and 73% received training on using the new inhaler. Patients used their new treatment for an average of 7 months prior to completing the survey. Patient satisfaction with the new therapy was high (PASAPQ; mean overall satisfaction: 6.2 for asthma; 6.0 for COPD; P=0.338). However, asthma was not well controlled (ACQ-6) in 62% of patients with asthma, and 56% of patients with COPD reported high/very high impact of their illness on their lives (CAT). Sixty-eight percent and 70% of patients with asthma and COPD, respectively, required reliever medication (≥3 puffs) most days during the week prior to the survey. There were no significant differences in disease control (ACQ-6, CAT) between once-daily and twice-daily treatments (P>0.05 for both asthma and COPD). CONCLUSION Even when reporting satisfaction with their new medication, objective measures showed substantial morbidity, regardless of DPI device or dosing regimen.
Collapse
Affiliation(s)
- Ileen Gilbert
- AstraZeneca, Wilmington, DE, USA
- Correspondence: Ileen Gilbert Email
| | | | | | | | - Laren Tan
- Loma Linda University Health, Department of Medicine, Division of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda, CA, USA
| |
Collapse
|
27
|
Weeda ER, Nguyen E, Martin S, Ingham M, Sobieraj DM, Bookhart BK, Coleman CI. The impact of non-medical switching among ambulatory patients: an updated systematic literature review. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2019; 7:1678563. [PMID: 31692904 PMCID: PMC6818107 DOI: 10.1080/20016689.2019.1678563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/28/2019] [Accepted: 10/04/2019] [Indexed: 05/31/2023]
Abstract
Background: Non-medical switching (NMS) is defined as switching to a clinically similar but chemically distinct medication for reasons apart from lack of effectiveness, tolerability or adherence. Objective: To update a prior systematic review evaluating the impact of NMS on outcomes. Data sources: An updated search through 10/1/2018 in Medline and Web of Science was performed. Study selection: We included studies evaluating ≥25 patients and measuring the impact of NMS of drugs on ≥1 endpoint. Data extraction: The direction of association between NMS and endpoints was classified as negative, positive or neutral. Data synthesis: Thirty-eight studies contributed 154 endpoints. The direction of association was negative (n = 48; 31.2%) or neutral (n = 91; 59.1%) more often than it was positive (n = 15; 9.7%). Stratified by endpoint type, NMS was associated with a negative impact on clinical, economic, health-care utilization and medication-taking behavior in 26.9%,41.7%,30.3% and 75.0% of cases; with a positive effect seen in 3.0% (resource utilization) to 14.0% (clinical) of endpoints. Of the 92 endpoints from studies performed by the entity dictating the NMS, 88.0%were neutral or positive; whereas, only 40.3%of endpoints from studies conducted separately from the interested entity were neutral or positive. Conclusions: NMS was commonly associated with negative or neutral endpoints and was seldom associated with positive ones.
Collapse
Affiliation(s)
- Erin R. Weeda
- The College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Elaine Nguyen
- Department of Pharmacy Practice, Idaho State University College of Pharmacy, Boise, ID, USA
| | - Silas Martin
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Michael Ingham
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | - Brahim K. Bookhart
- Real World Value & Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | |
Collapse
|
28
|
Affiliation(s)
- Mohammed K Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Megha K Shah
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| |
Collapse
|
29
|
Vanderpoel J, Tkacz J, Brady BL, Ellis L. Health Care Resource Utilization and Costs Associated With Switching Biologics in Rheumatoid Arthritis. Clin Ther 2019; 41:1080-1089.e5. [DOI: 10.1016/j.clinthera.2019.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/07/2019] [Accepted: 04/18/2019] [Indexed: 11/30/2022]
|
30
|
Dolinar R, Kohn CG, Lavernia F, Nguyen E. The non-medical switching of prescription medications. Postgrad Med 2019; 131:335-341. [DOI: 10.1080/00325481.2019.1618195] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Christine G. Kohn
- University of Connecticut School of Medicine, Farmington, CT & UConn/Hartford Hospital Evidence-based Practice Center, Hartford, CT, USA
| | | | - Elaine Nguyen
- Idaho State University College of Pharmacy, Meridian, ID, USA
| |
Collapse
|
31
|
Teeple A, Ginsburg S, Howard L, Huff L, Reynolds C, Walls D, Ellis LA, Curtis JR. Patient attitudes about non-medical switching to biosimilars: results from an online patient survey in the United States. Curr Med Res Opin 2019; 35:603-609. [PMID: 30618353 DOI: 10.1080/03007995.2018.1560221] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate patient attitudes regarding non-medical switching (NMS) to biosimilars among patients with autoimmune disease currently receiving a biologic. METHODS An online survey was conducted among patients meeting the following criteria: ≥18 years of age; residing in the US; diagnosis of rheumatoid arthritis, Crohn's disease, ulcerative colitis, psoriasis or psoriatic arthritis; currently taking a biologic; and consenting to participate. Patients answered questions about their attitudes and experiences related to NMS. Descriptive statistics were used to summarize responses. RESULTS A total of 1696 patients completed the 20-min survey. Eighty-five per cent of patients were concerned that biosimilars wouldn't treat their disease as well; 85% didn't want to switch to a biosimilar if their current biologic was helping their disease; and 83% were concerned that switching may cause more side-effects. Twenty per cent of patients had previously received notification about a potential NMS to another biologic (that was not a biosimilar) from their insurance company. Of these, 79% took at least one action to avoid the NMS and 45% ultimately switched. Of these patients (n = 150), 67% indicated that their previous biologic worked well for them and 70% didn't want to switch to another biologic. Most patients who switched (67%) did so to avoid paying a higher cost. More than half (56%) went without therapy for administrative reasons during the period of transition from the old biologic to the other treatment. CONCLUSIONS Patients reported multiple concerns about NMS that might impact treatment outcomes, and many of the patients who non-medically switched in this survey missed treatments. Future studies should be conducted on patient expectations and experiences with NMS to understand the impact on healthcare delivery, treatment persistency, and patient outcomes. The patient perspective and experience should be considered by decision-makers when developing coverage policies for biosimilar medications and associated communication strategies.
Collapse
Affiliation(s)
- A Teeple
- a Janssen Scientific Affairs, LLC , Horsham , PA , USA
| | - S Ginsburg
- b Global Health Living Foundation , Upper Nyack , NY , USA
| | - L Howard
- c National Psoriasis Foundation , Alexandria , VA , USA
| | - L Huff
- d Benfield, a Division of Gallagher Benefit Services, Inc. , Webster Groves , MO , USA
| | - C Reynolds
- d Benfield, a Division of Gallagher Benefit Services, Inc. , Webster Groves , MO , USA
| | - D Walls
- e BDJ Solutions, LLC ; Melrose , MA , USA
| | - L A Ellis
- a Janssen Scientific Affairs, LLC , Horsham , PA , USA
| | - J R Curtis
- f University of Alabama at Birmingham , Birmingham , AL , USA
| |
Collapse
|
32
|
Numan S, Faccin F. Non-medical Switching from Originator Tumor Necrosis Factor Inhibitors to Their Biosimilars: Systematic Review of Randomized Controlled Trials and Real-World Studies. Adv Ther 2018; 35:1295-1332. [PMID: 30084060 PMCID: PMC6133136 DOI: 10.1007/s12325-018-0742-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 02/06/2023]
Abstract
Tumor necrosis factor (TNF) inhibitors are widely used biologics for the treatment of several chronic inflammatory diseases. The launch of anti-TNF biosimilars has introduced the possibility of non-medical switching between originator biologics and their biosimilars. However, the potential clinical and patient-reported consequences of non-medical switching remain largely unknown, as much of the evidence comes from poorly or uncontrolled real-world evidence (RWE) studies that often have an element of bias and nonstandardized outcome measures. To appropriately evaluate the safety, efficacy, and immunogenicity of non-medical switching from an originator to its biosimilar, we propose that seven key study design elements should be considered when assessing the existing evidence: studies should be (1) randomized and double-blind, (2) adequately controlled, and (3) adequately powered; include (4) multiple switching, (5) an assessment of immunogenicity, and (6) adequate follow-up duration; and (7) report individual patient-level outcomes. This systematic review assessed the robustness and consistency of the current non-medical switching evidence, with a focus on TNF inhibitors. A comprehensive literature search (January 2012-February 2018) identified 98 publications corresponding to 91 studies (17 randomized controlled trials and 74 RWE studies) describing non-medical switching from a TNF inhibitor originator to its biosimilar. When assessing the totality of this evidence, none of the non-medical switching studies conducted to date were found to use all seven of the key design elements, and the absence of these elements dilutes the robustness of the data. Furthermore, discontinuation rates varied widely among studies (0-87%), suggesting heterogeneity and inconclusiveness of the current efficacy, safety, and immunogenicity evidence, particularly at an individual patient level. Therefore, patients should not be indiscriminately switched from an originator TNF inhibitor to its biosimilar for non-medical reasons. Switching decisions should remain between the treating physicians and their patients and be made on a case-by-case basis, relying upon robust scientific evidence. FUNDING AbbVie.Plain Language Summary: Plain language summary available for this article.
Collapse
|
33
|
Flores NM, Patel CA, Bookhart BK, Bacchus S. Consequences of non-medical switch among patients with type 2 diabetes. Curr Med Res Opin 2018; 34:1475-1481. [PMID: 29661086 DOI: 10.1080/03007995.2018.1465904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to describe real-world experiences following a non-medical switch among adults with type 2 diabetes mellitus (T2DM) in the United States. METHODS For this cross-sectional study, patients with T2DM (N = 451) provided data on demographics, and how a non-medical switch of their anti-hyperglycemic agent (AHA) affected their general health, HbA1c levels and medication management, via an Internet-based survey. Patients self-reported their level of satisfaction with the original medication and emotional reactions to the non-medical switch. Patients who recently experienced a non-medical switch of their AHA(s) (n = 379) were asked about the consequences of switching and their satisfaction with the switch (vs. the original) medication. RESULTS Patients most frequently reported feeling very/extremely frustrated, surprised, upset and angry in reaction to a non-medical switch. Patients were somewhat satisfied with their original medication. Between 20% and 30% of patients reported the non-medical switch had a moderate/major effect on their general health, diabetes, mental well-being and control over their health. The blood glucose levels of recent switchers were somewhat/much worse (20.7%) and medication management was somewhat/much worse (12.9%) on the switch (vs. the original) medication. Some recent switchers reported old symptoms returning (7.7%) and experiencing new side-effects (14.2%). CONCLUSIONS Approximately one in five patients reported a moderate/major negative impact on their blood glucose level, diabetes, mental well-being, general health and control over their health following a non-medical switch. Findings suggest that a non-medical switch may have unintended negative health consequences and results in considerable burden across multiple domains for a sizeable minority of patients with T2DM.
Collapse
Affiliation(s)
- Natalia M Flores
- a Health Outcomes Research , Kantar Health , Foster City , CA , USA
| | - Charmi A Patel
- b Health Economics & Outcomes Research , Janssen Pharmaceuticals Inc. , Titusville , NJ , USA
| | - Brahim K Bookhart
- b Health Economics & Outcomes Research , Janssen Pharmaceuticals Inc. , Titusville , NJ , USA
| | - Shaffeeulah Bacchus
- c Health Economics & Clinical Outcomes Research , Janssen Pharmaceuticals Inc. , Titusville , NJ , USA
| |
Collapse
|
34
|
Blonde L, Burudpakdee C, Divino V, Bookhart B, Cai J, Pfeifer M, Coleman CI. The impact of non-medical switch on type 2 diabetes patients treated with canagliflozin in the commercially insured US population. Curr Med Res Opin 2018; 34:1501-1511. [PMID: 29671627 DOI: 10.1080/03007995.2018.1467887] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess the impact of non-medical switch (NMS) from canagliflozin on antihyperglycemic agent (AHA) medication taking behavior. METHODS This retrospective real-world database analysis included patients with type 2 diabetes with a prescription claim for canagliflozin (CANA) between August 2015 and January 2016 using administrative claims and longitudinal prescription data. Patients with NMS from canagliflozin were identified as those with discontinuation or switch of canagliflozin and enrolled in a pharmacy benefit manager that removed CANA from formulary in 2016. Patients with NMS were propensity score matched to patients without NMS. Patients had a 6 month baseline period and a 4 month follow-up period. RESULTS The study sample comprised 668 patients with NMS matched to 668 patients without NMS (52.4% and 49.9% male, mean age 55.6 and 55.7, respectively). Among patients with NMS, half (52.8%) did not switch to a new AHA medication (i.e. abandoned therapy) after discontinuation of CANA, while the remaining 47.2% switched to a new AHA medication. Over the 4 month follow-up, patients with NMS used significantly fewer unique AHA products compared to patients without NMS (mean [SD] 2.13 [1.40] vs. 2.66 [1.02], p < .0001). Over the 4 month follow-up, 16.5% of patients with NMS had no use of any AHA; by definition, patients without NMS used at least 1 AHA (i.e. canagliflozin). CONCLUSIONS Among patients with NMS, therapy abandonment was a major unintended consequence. Further research is needed to investigate the impact of NMS on clinical outcomes as well as the impact of NMS over a longer follow-up.
Collapse
Affiliation(s)
- Lawrence Blonde
- a Frank Riddick Diabetes Institute , Department of Endocrinology , Ochsner Medical Center , New Orleans , LA , USA
| | | | | | | | - Jennifer Cai
- c Janssen Scientific Affairs LLC , Titusville , NJ , USA
| | | | - Craig I Coleman
- e University of Connecticut School of Pharmacy , Storrs , CT , USA
- f Hartford Hospital Evidence-Based Practice Center , Hartford , CT , USA
| |
Collapse
|
35
|
Scherlinger M, Schaeverbeke T. Additional response to the correspondence: ‘Switching from the bio-originators to biosimilar: is it premature to recommend this procedure?’ by Cantini and Bennuci. Ann Rheum Dis 2018. [DOI: 10.1136/annrheumdis-2018-213342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
36
|
Patel D, Park KT. Path of Interchangeability of Biosimilars in Pediatric Inflammatory Bowel Disease: Quality Before Cost Savings. J Pediatr Gastroenterol Nutr 2017; 65:134-136. [PMID: 28319603 PMCID: PMC5524607 DOI: 10.1097/mpg.0000000000001572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The advent of biosimilars in inflammatory bowel disease (IBD) represents an opportunity for cost-savings and increased patient access to effective disease-modifying therapies. While preliminary data in adult IBD and rheumatology patients suggest comparable effectiveness and pharmacokinetics between original biologics and biosimilars, long-term immunogenicity data are unknown. Without this data, conclusions about interchangeability should not be made for pediatric patients with IBD. Children affected by IBD, in particular, are a vulnerable group if automatic substitution and non-medical switching are allowed based on limited data in adult patients. Robust, long term immunogenicity data of biosimilars are needed in pediatric cohorts before policies allow interchangeability in children.
Collapse
Affiliation(s)
- Dimple Patel
- Saint Louis University School of Medicine, Saint Louis, MO
| | - KT Park
- Department of Pediatrics, Division of Gastroenterology, Stanford University Medical Center, Palo Alto, CA
| |
Collapse
|
37
|
Attara G. Pharmacare: Are we getting the right medicines? Healthc Manage Forum 2017; 30:193-196. [PMID: 28929869 DOI: 10.1177/0840470417696710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Canada is the only country in the world with a national healthcare plan that does not include drug coverage. Coverage of necessary medications is a patchwork of inconsistent programs that does not always serve the very individuals it was created to help-those patients who need prescribed medicines. Our system needs radical, intuitive changes.
Collapse
Affiliation(s)
- Gail Attara
- 1 Gastrointestinal Society, Vancouver, British Columbia, Canada
| |
Collapse
|