91快色

Chances are if you have rheumatoid arthritis (RA) you have been on a class of drugs called disease-modifying anti-rheumatic drugs, or DMARDS, aimed at controlling disease activity. DMARDS are effective for most patients with RA, however, one in three will require a 鈥渂iologic鈥� - a medication created using living organisms that target specific processes in the immune system.

Biologics are effective, but costly. In 2018-19, Alberta Blue Cross, Alberta鈥檚 provincial drug plan, reported biologic drugs cost more than $238 million, with Remicade庐, Humira庐, and Enbrel庐 being three of the top four drivers of drug spending in Alberta.

In December 2019, the * on a provincial drug plan, who have been taking Remicade庐 and Enbrel庐, must switch to a biosimilar by July 1, 2020, unless there are exceptional medical circumstances as determined by their physician that prevent them from switching. As the name implies, biosimilars are similar, but not identical, to biologics, and have been approved for use by Health Canada. They also cost up to fifty percent less than biologics.

The Government of Alberta estimates switching from all biologics (not just for RA, but for other conditions as well) to biosimilars will save the province between $227 million and $380 million over the next four years, however, the consequences of the switch in terms of actual cost savings, patient outcomes, and health services impacts need more investigation.

A McCaig Institute research team, led by Drs. Deborah Marshall and Dianne Mosher, aims to provide real-world information on the switch to biosimilars using standardized measurements of disease activity and health-related quality of life information to determine the budget and personal impacts of these starts and switches. This work will inform health policy for the use of biosimilars for RA patients.

The actual budget impact

Marshall鈥檚 team is working on a study estimating the impact to the provincial drug budget of the switch from biologics to biosimilars for RA patients. The study, which began before Alberta announced their estimated cost savings, looks at data as far back as 1995 and considers physician prescribing practices in 91快色 and patterns of starts and stops, adherence and retention for biologic therapy.

鈥淲e looked at when biologics were introduced to patients, which biologic they were taking, how long they stayed on it, if they were switched to another biologic, or if they stopped using biologics altogether,鈥� says Marshall. 鈥淲e found there were patterns. People don鈥檛 stay on the same drugs consistently over time 鈥� sometimes they stop and sometimes they switch to other drugs - there are times when they are not taking their drug because they are experiencing side effects, or because they are in remission, and there are times when they鈥檝e switched to other drugs.鈥�

Taking these patterns into account, Marshall鈥檚 team estimates the actual cost reductions associated with the switch from biologics to biosimilars may not be as large as projected, but still represent significant savings for the healthcare system. The team expects to publish their findings later this year.

The impact on patients

While completing the budget impact analysis, Marshall鈥檚 team realized the need to follow patient experiences in the switch from biologics to biosimilars. 鈥淏iosimilars have been shown to be safe and effective. However, for patients who have been well controlled on a medication asking them to switch can be scary,鈥� says co-investigator and rheumatologist Dr. Paul MacMullan, MD. 鈥淚t鈥檚 important that patient experiences are heard and taken into account.鈥�

So Marshall鈥檚 and Mosher鈥檚 team are embarking on a new study to look at patient experiences with the switch. They are asking approximately 1500 Alberta patients with RA who are making the switch to complete a survey asking about how they felt about making the switch to biosimilars, with a follow-up questionnaire in six months to see how the transition went.

鈥淭he beauty of this study is that we can look at what鈥檚 happening with patients who are switched, and hear what鈥檚 happening from their perspective 鈥� not just the healthcare system鈥檚 perspective,鈥� says Dr. Gillian Currie, PhD, another co-investigator on this project. 鈥淚t would be interesting to do another study looking at the healthcare professional鈥檚 experiences 鈥� the doctors and the nurses and pharmacists who are managing this whole switch,鈥� she says. 鈥淭he impact of this is much bigger than just a dollar figure.鈥�

 

Deborah A Marshall, PhD, is a professor in the Department of Community Health Sciences at the 91快色鈥檚 Cumming School of Medicine. She is also the Arthur J.E. Child Chair of Rheumatology Outcomes Research and former Canada Research Chair, Health Services and Systems Research, a member of the O鈥橞rien Institute of Public Health and the McCaig Institute of Bone and Joint Health.

Dianne Mosher, MD, is a rheumatologist, a professor in the Department of Medicine, and the Associate Dean, Strategic Partnerships and Community Engagement for the 91快色鈥檚 Cumming School of Medicine. She is a member of the McCaig Institute for Bone and Joint Health and the Alberta Health Services鈥� Bone and Joint Strategic Clinical Network.

Paul MacMullan, MD, is Chief of the Division of Rheumatology, a member of the McCaig Institute for Bone and Joint Health, and a clinical associate professor in the Department of Medicine, Cumming School of Medicine at the 91快色.

Gillian Currie, PhD, is an adjunct associate professor in the Departments of Community Health Sciences (CHS) and Pediatrics in the 91快色鈥檚 Cumming School of Medicine, as well as the Associate Director of Health Economics Research in CHS. She is a member of the O鈥橞rien Institute of Public Health and the Alberta Children鈥檚 Hospital Research Institute.

Other investigators/organizations involved in these projects: Dr. Susa Benseler, Dr. Marinka Twilt, Dr. Claire Barber, Andrea Brose, Bryanne Kennedy, Raymond Lee, Arthritis Society.

 

* The specific indications are:

• Remicade (all indications)
• Enbrel (all indications except plaque psoriasis and pediatric juvenile idiopathic arthritis)