Prescribing data, metrics or supporting resources
Biosimilar versions of epoetin, filgrastim and somatropin have been available for some time. Biosimilar versions of infliximab (Inflectra, Remsima and Flixabi); etanercept (Benepali and Erelzi); rituximab (Rixathon and Truxima); and insulin glargine (Abasaglar) have been launched in the UK. Further biosimilar versions of adalimumab, bevacizumab, pegfilgrastim, and trastuzumab are expected to be available in the next few years.
Biosimilars have the potential to offer the NHS considerable cost savings, especially as biological medicines are often expensive and are often used to treat long-term conditions. The NHS England publication, What is a biosimilar medicine? states that biosimilar medicines are more challenging and expensive to develop than generic medicines. Whilst they cannot offer the same percentage price reductions as traditional generic medicines, nevertheless, there are significant savings associated with increased competition between biological medicines, including biosimilar medicines. Recent research has given clear evidence that the additional competition is bringing value and opportunity to widen access for patients in some circumstances. However, this research also demonstrates that biosimilar medicine uptake across Europe to date shows very different patterns, depending on the class of biological medicine and the procurement measures in place. Costs for both biosimilar and originator biological medicines may vary locally depending on local contractual arrangements, and Regional Pharmacy Procurement Specialists will be able to provide more details.
The selection of metrics to support key therapeutic topics is overseen by the NHS England Medicines Optimisation Intelligence Group, and work is ongoing in this area. At this point, the following metrics have been identified by this group to support this topic.
Prescribing metrics on biosimilars are included in the Medicines optimisation dashboard, which brings together a range of medicines-related metrics from across sectors. These are:
Biosimilars: % of infliximab biosimilars uptake, which is the percentage of defined daily doses for the biosimilar versions of infliximab
Biosimilars: % of etanercept biosimilars uptake, which is the percentage of defined daily doses for the biosimilar versions of etanercept.
There is an intention to include other biosimilar medicines in the medicines optimisation dashboard as they become available. The medicines optimisation dashboard helps NHS organisations to understand how well their local populations are being supported to optimise medicines use and inform local planning. The dashboard allows NHS organisations to highlight variation in local practice and provoke discussion on the appropriateness of local care. It is not intended as a performance measurement tool and there are no targets.
There are also prescribing metrics on biosimilar infliximab, etanercept and rituximab in the NHS Improvement Model Hospital portal (requires log in). These metrics form part of the Top 10 Medicines sub-compartment of the Hospital Pharmacy & Medicines Optimisation section of the Model Hospital. This system has evolved from the simple uptake of the biosimilars (which is still included) to provide a monetised target and delivery of savings made through the individual trusts current uptake of each product. The data are provided using the Define benchmarking tool which 95% of acute trusts in England have purchased licences for and provide data into. The metric uses the defined daily dosage (DDD) of the biosimilar product used in a month as the numerator and the total DDD of the originator and biosimilar product used as the denominator. The data are displayed as a time series to show improvement over time and usage against other trusts and the national median. Additionally, the average cost per DDD is used to calculate a target saving for each trust if they have switched to 80% uptake of the biosimilar. An annual and monthly financial target, with the percentage uptake and savings delivered is given, which forms part of a monthly updated integrated performance framework to show individual trust savings delivery.
Since launch, the uptake of biosimilar infliximab, etanercept and rituximab has been variable across the country, with early adopter sites rapidly achieving greater than 90% adoption whilst other sites have slower uptake. The rate of biosimilar diffusion is, however, increasing and plans are in development to prepare for the launch of biosimilar adalimumab to maximise day 1 uptake.
The Model Hospital continues to be developed to support the principles and objectives developed from the Carter Review, Operational productivity and performance in English NHS acute hospitals: unwarranted variations. In addition to a range of infrastructure and service delivery related metrics, a range of clinical and medicines-related metrics have been developed, with additional metrics being added. These are linked to national commissioning and medicines optimisation developments. The Top 10 medicines are a key element of the Medicines Value Programme across NHS England & NHS Improvement as identified within the next steps on the Five Year Forward View.
One of the Hospital Medicines Optimisation Commissioning for Quality and Innovation (CQUIN) scheme priority areas for implementation is faster adoption of best value medicines with a particular focus on the uptake of best value generics, biologics and commercial medicines unit frameworks as they become available. See NHS England 2017 – 2019 Prescribed Services CQUIN Schemes for more details. In order to allow NHS England to continue to invest in new developments there are requirements for all hospitals to use more cost-effective generic and biosimilar products where these are available and in line with product licences.