NHS 'Wasting Money' With Slow Uptake of Biosimilar Drugs

Peter Russell

August 01, 2018

Greater use of biosimilar and generic medicines would save the NHS money without compromising patient care or safety, researchers have said.

Biosimilars are medicines that are designed to have active properties that closely resemble other already approved drugs and are themselves approved to the same standards of pharmaceutical quality, safety, and effectiveness.

The NHS said it saved £324 million during the last financial year by switching from 10 expensive medicines to better value and equally effective alternatives.

Costly Inertia

However, in an editorial in The BMJ, two clinical pharmacologists and a senior clinical research fellow in the UK have argued that slow adoption of biosimilars has proved costly for the health service.

For example, their research suggested that insulin glargine (Lantus, Sanofi-Aventis) is being prescribed to 40% of diabetes patients, rather than the biosimilar generic version, Abasaglar, which has been licenced in the UK since September 2015. This was despite the originator medicine costing 7% more, they said.

According to the National Institute for Health and Care Excellence (NICE), the insulin glargine biosimilar was as effective in two randomised control trials as the originator medicine at reducing HbA1c levels in people with type 1 and type 2 diabetes. Also, the safety profile of Abasaglar was comparable to that of Lantus.

Uptake of the biosimilar version varied considerably between English clinical commissioning groups, the editorial said.

'Lack of Familiarity'

"Reasons for the poor uptake of biosimilars may include lack of familiarity, therapeutic inertia, concern about patient confusion over different brand names and different looking formulations, perceived lack of efficacy, and the nocebo effect," according to the authors. They said the cost implications were significant because originator medicines typically cost 10% more than biosimilars.

"When a biosimilar has been licensed, there should be no concerns about starting treatment with it rather than the originator," the authors concluded. "And switching to a cheaper product in a patient who is already taking an originator can also be recommended when there is high quality evidence of equivalence of the benefits and harms, provided progress is carefully monitored."

NHS Savings Target

According to NHS Improvement, a savings target of £250 million set in 2017-18 for NHS trusts that used the most expensive medicines was exceeded by £74 million. It said it hoped savings would reach £200 million in the current financial year.

Biosimilar and generic medicines for treating rheumatoid arthritis, some forms of cancer, and inflammatory bowel conditions were responsible for much of the savings.

Biosimilars of trastuzumab for treating breast cancer were approved by NHS England as an alternative to the branded Herceptin (Roche) last month, NHS Improvement said.

Health charities welcomed the move. Carolyn Rogers, clinical nurse specialist at Breast Cancer Care, commented: "Although some may be unnerved that these drugs are different to the original, it is crucial people with breast cancer feel reassured they are just as safe and effective.

"While new for breast cancer, biosimilars have been used for other diseases for years. And with our incredibly overstretched NHS, switching costly medicines for less expensive but rigorously tested alternatives is a step in the right direction."

Prescribing biosimilars. BMJ 2018; 362 (Published 24 July 2018) BMJ 2018;362:k3141. Abstract.


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