Rapid monitoring of health services utilization following a shift in coverage from brand name to biosimilar drugs in British Columbia—An interim report

Abstract

Purpose: We explored changes in health services utilization associated with the Biosimilars Initiative introduced in British Columbia on May 27, 2019. To maintain drug coverage, the policy requires users of originator infliximab or etanercept to transition to biosimilar versions. We present a three-month interim analysis of this initiative. Methods: We conducted a rapid monitoring analysis to evaluate changes in health services utilization three months after the policy was introduced compared with a threeyear period before the policy's introduction. Using the administrative claims data of the British Columbia Ministry of Health, we assembled three historical cohorts and one policy cohort of users of each originator drug (8 cohorts in total). Cumulative incidences of medication refills, switching, and visits to physicians were the outcome measures used to compare policy and historical cohorts. Likelihood ratios were used to quantify statistical differences between each policy cohort and its respective historical controls. Likelihood ratios above 7.1 were considered statistically significant. Results: The four infliximab cohorts included 436 patients on average, mean age 56 to 59, 53% to 55% females. The four etanercept cohorts included 1826 patients on average, mean age 57 to 58, 60% to 63% females. Three months after the policy's introduction, 21% of patients treated in the policy cohorts transitioned to the biosimilar versions. Health services utilization in the policy cohorts were consistent with the historical cohorts. Conclusions: An increase in visits to physicians was expected but not detected in the first three months of the Biosimilars Initiative. The impacts of the policy will continue to be monitored.

Mandatory nonmedical switching from originator to biosimilar infliximab in patients with inflammatory arthritis and psoriasis in British Columbia: a cohort study

“…This study had several limitations. 25 First, we did not test hypotheses and hence are unable to support or reject the null hypothesis of no difference in health services utilization after the policy was launched. As such, we did not adjust for patient characteristics, and differences in patient characteristics could lead to changes in clinical practice and health services utilization.…”

“…The launch of the Biosimilars Initiative was followed by real-time monitoring of its impacts. 23 – 25 Some impacts were expected, such as an increase in visits to specialists during the 6-month transition period or immediately thereafter because of patient–physician consultations needed to monitor a switch to a biosimilar. 10 , 14 Also, a shift in health services utilization was expected beginning Mar.…”

Effect of listing strategies on utilization of antitumor necrosis factor biologics infliximab and etanercept: a cross-sectional analysis from Ontario, Canada

“…This includes Manitoba (tiered reimbursement), 29 British Columbia (switching of patients from specific innovator to biosimilar products), 30 and most recently Alberta (tiered reimbursement and switching to be implemented by January 2021). 31 These policy changes are anticipated to, and have already indicated that they will, improve biosimilar uptake 32 and should be considered in Ontario and other jurisdictions in Canada, as well as globally to further improve uptake and reduce costs.…”

Rapid monitoring of health services use following a policy to switch patients from originator to biosimilar etanercept—a cohort study in British Columbia

“…We conducted rapid monitoring of health services utilization [ 25 , 26 ] using a prospective cohort study design and administrative data from the BC Ministry of Health. The data included population-based, province-wide information on prescriptions filled in all community pharmacies, diagnoses recorded in visits to physicians and other providers, hospital and emergency department records, and medical services registration data.…”

“…These methodologies require significant resources and are limited to a single analysis, which is often delayed. The aim of this rapid monitoring analysis was to detect signals of intended and unintended impacts on health services utilization over a one-year period following the launch of the Biosimilars Initiative for patients treated with originator etanercept [ 25 , 26 ]. Our study was designed to detect potential signals of unintended negative impacts in an entire population, and not to accept or reject a hypothesis of harm in the presence of a sampling error.…”