Increasing Biosimilar Utilization at a Pediatric Inflammatory Bowel Disease Center and Associated Cost Savings: Show Me the Money

Abstract

Background Tumor necrosis factor-alpha inhibitors (anti-TNFs) are a primary treatment for inflammatory bowel disease. Pharmaceutical expenditures and usage of specialty drugs are increasing. In the United States, biosimilars continue to be underutilized, despite opportunities for health care cost savings. Through quality improvement (QI) methodology, we aimed to increase biosimilar utilization among eligible patients initiating intravenous (IV) anti-TNF therapy and describe patient outcomes and associated cost savings. Methods Beginning in July 2019, all patients initiating IV anti-TNF therapy were identified and tracked. Using the Institute of Healthcare Improvement Plan-Do-Study-Act cycle, a four-stage problem-solving model used for carrying out change, we trialed interventions to increase biosimilar utilization, including provider, staff, and family education, and utilization of a clinical pharmacist and insurance specialist. Statistical process control charts were used to show improvement over time. Patients’ clinical outcome and cost savings were reviewed. Results Using QI methodology, we increased biosimilar utilization from a baseline of 1% in June 2019 to 96% by February 2021, with sustained improvement. The originator (infliximab) was the insurance company’s preferred product for 20 patients (20%). Patient outcomes (IV anti-TNF levels, absence of antidrug antibodies, and physician global assessment) between biosimilars and originators were similar. Estimated cost savings over the project duration were nearly $381,000 (average sales price) and $651,000 (wholesale acquisition cost). Conclusions Through QI methodology, we increased biosimilar utilization from 1% to 96% with sustained improvement, without compromising patient outcomes or safety. Estimated cost savings were substantial. Similar methodology could be implemented at other institutions to increase biosimilar utilization and potentially decrease health care costs.

Patient and Caregivers’ Perspectives on Biosimilar Use in Pediatric Inflammatory Bowel Disease

“…The percentages on the far right (in light gray) are a sum of those that rated the question as strongly agree and agree. pediatric patients about biosimilars (10). This initiative increased the utilization of IV anti-TNF biosimilars from 1% at baseline to 96% among patients previously naïve to anti-TNF therapy and we have shown sustained improvement.…”

“…In addition, it highlights the need to educate patients and their caregivers on the efficacy and safety of biosimilars, especially as non-medical switches are becoming more common by insurance companies and due to majority of patients and caregivers having no prior knowledge of biosimilars. Quality improvement strategies have shown to be effective at improving education amongst pediatric patients and their caregivers about biosimilars before therapy initiation (10). Caregivers that have previously heard of biosimilars will require reeducation on the safety and efficacy of biosimilars in order to impact their negative perception.…”

“…no prior knowledge of biosimilars. Quality improvement strategies have shown to be effective at improving education amongst pediatric patients and their caregivers about biosimilars before therapy initiation (10). Caregivers that have previously heard of biosimilars will require reeducation on the safety and efficacy of biosimilars in order to impact their negative perception.…”

“…In an effort to impact healthcare expenditures, the first anti-TNF biosimilar was approved in 2016 and biosimilars are estimated to be 10-50% less expensive than the originator (5,6). Biosimilars are biological products with similar rates of remission, adverse events, and adverse effects compared to the originator (7)(8)(9)(10)(11)(12). Switching from the originator to a biosimilar, has shown to not effect on efficacy or immunogenicity (7,12,13).…”

Biosimilars in Pediatric IBD: Updated Considerations for Disease Management

“…Patient education is also an important aspect of the acceptance of biosimilar treatment. Morris et al 60 have recently demonstrated the successful application of a quality improvement approach to boost biosimilar use from 1% to 96% in intravenous anti-TNF-α naïve pediatric patients. This was achieved through substantial provider and patient education and expediting the prior authorization process for all inpatient and outpatient biosimilar starters.…”