Improving supportive care: lessons we can learn from the introduction of biosimilars into general healthcare
Abstract published: August 2021
Several efforts have been introduced to improve access to biosimilars and deliver cost savings to healthcare systems. This review considers some of these recent initiatives.
Biosimilar use is set to increase significantly in cancer patients requiring supportive care; however, several challenges to implementing biosimilars into clinical practice remain.
Epoetin-α is an erythropoeisis-stimulating agent (ESA) that improves haemoglobin levels in patients receiving chemotherapy and reduces their need for blood transfusions. Since the first epoetin-a biosimilar was launched in Europe in 2007, many short- and long-acting biosimilar versions of this drug have been made available worldwide, with apparently similar degrees of efficacy. The introduction of biosimilar ESAs and consequent cost reductions for these drugs in the UK led the National Institute for Health and Care Excellence (NICE) to review its stance on their cost-effectiveness and subsequently to approve them for reimbursement on the NHS, in 2014. Similarly, there is now acceptance and expanded use of biosimilar versions of filgrastim across Europe and the USA.
Despite the known advantages of adopting biosimilars into oncology practice, there is a lack of confidence among prescribers. Areas where healthcare professionals report having knowledge gaps include the biosimilars approval processes, pharmacovigilance, and concepts of extrapolation and interchangeability. Patients, caregivers and the general public also may not accept biosimilars, therefore good-quality education resources for HCPs and patients alike have been made available by a number of bodies including professional societies and government organizations, along with continued gathering and dissemination of pharmacovigilance and pharmacoeconomics data.
Differences in the way biosimilars are commissioned and reimbursed can also influence uptake. Healthcare policies that incentivize competition and sustainable pricing, such as value-based care schemes, ensure manufacturers continue to invest in the biosimilars market. The UK Cancer Vanguard project provides a good example of an initiative to speed up biosimilar uptake – in this case, rituximab. This project, which included stakeholder engagement and teaching materials, financial incentives and targets for implementation, was rewarded with biosimilar infliximab achieving 90% market share within 12 months.
Clearly, to enhance access to biosimilars in supportive care, several existing barriers should be addressed. These include increased standardization of regulation, commissioning and reimbursement, better product availability and not least, clearer understanding of the broad usefulness of biosimilars.
Prescribers and patients often lack knowledge about biosimilars, thus lowering their acceptance in clinical care. There are knowledge gaps in several areas (e.g., approval processes, pharmacovigilance, and extrapolation and interchangeability) which need to be addressed before take-up increases. Healthcare policies incentivising competition and sustainable pricing ensure manufacturers continue to invest in the biosimilars market.