Background CT-P13 is an infliximab biosimilar that was granted market authorization in Switzerland in 2016. Despite the growing literature supporting the equivalence of CT-P13 compared with originator infliximab regarding the efficacy, safety, and immunogenicity and the undeniable cost-saving opportunities, CT-P13 remains widely underused in Switzerland. Objective Leaving aside the phenomenon of a low initiation rate, this study aimed to explore the reasons behind the high discontinuation rate observed among the patients taking CT-P13 in a large tertiary hospital in Western Switzerland. Methods We performed a retrospective cohort study using routinely collected data. Patients were eligible if they received originator infliximab or CT-P13 between September 2017 and December 2020. They were included if they had received at least two CT-P13 infusions during the same period. Patients were excluded if the follow-up was incomplete prior to or 6 months after their first CT-P13 infusion and if they had an oncological main diagnosis. Primary outcomes were the reasons for treatment discontinuation. Results One hundred and fifty-six patients were included and classified into two groups: switchers who were treated with originator infliximab and were switched to CT-P13 ( n = 85, 54%) and initiators who did not receive originator infliximab prior to CT-P13 treatment ( n = 71, 46%). Included patients belonged to three different groups of diagnosis: gastroenterological (67, 43%), rheumatological (61, 39%), and immunological (28, 18%). Twenty-three (27%) switchers and 35 (49%) initiators discontinued CT-P13 after 12 months. Main reasons for CT-P13 discontinuation were lack of efficacy ( n = 21, 36%) and secondary loss of response ( n = 16, 28%); however, objective assessments were not available. Initiators’ probability to discontinue CT-P13 at 12 months was significantly higher than switchers’ ( p < 0.01). Conclusions Lack of efficacy and secondary loss of response were the main reasons for the high CT-P13 discontinuation rate observed in a large tertiary hospital in Western Switzerland. Lack of active training and coordination among healthcare professionals and little education in patients may have exacerbated patients’ subjective complaints and increased the CT-P13 discontinuation rate. Supplementary Information The online version contains supplementary material available at 10.1007/s40801-022-00299-2.
Objectives: To perform an overview of systematic reviews of economic evaluations of pharmacy services and triangulate results with recommendations for economic evaluations of public health interventions and recommendations for economic evaluations alongside trials. Methods: 1) Exploratory review of recommendations on the economic evaluation of public health interventions; 2) Exploratory review of recommendations for conducting economic evaluations alongside trials; 3) Overview of systematic reviews of economic evaluations of pharmacy interventions in 8 databases. Methods are detailed in protocol registered with PROSPERO (http://www. crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016032768). A threefold critical appraisal of the methodology was performed: 1) Quality of included reviews; 2) Quality of evidence of community pharmacy primary studies reported in reviews; 3) Applicability and transferability. Results: Fourteen systematic reviews containing 75 index publications were included. Reviews reported favorable economic findings for 71% of studies with full economic evaluations. The types of economic analysis are diverse. Two critical quality domains are absent from most reviews. Key findings include: certain types of risk of bias more frequent; wider scope of study designs; most economic quality criteria are met but some issues unresolved or unclear; heterogeneity in populations, interventions and some outcomes; equity not assessed; process dimensions poorly described. Triangulation reveals additional gaps. Conclusions: The economic evaluation of pharmacy interventions presents challenges. Since in recent years, payers made substantial changes in pharmacy remuneration systems, including contracting with Pharmacies and paying for relevant interventions, we hope these findings may assist in improving the design, implementation and assessment of pilot trials, hence the robustness of evidence to justify payers' investment. We also propose a methodological approach for future research in performing economic evaluations of pharmacy-based public health interventions. As research expands, it will become important to build a multidisciplinary expert consensus around a specific guidance on economic evaluation of pharmacy-based public health interventions.
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