gms | German Medical Science

Background: Biologicals are highly potent treatment options for autoimmune diseases such as inflammatory bowel diseases, rheumatoid arthritis, psoriatic arthritis, and chronic plaque psoriasis. However, the disadvantage of these treatments is that they are highly expensive. Biosimilars are a cost-effective alternative to their original reference products. According to multiple studies, the treatment with biosimilars is not inferior in terms of clinical efficacy and safety [1], [2]. Moreover, switching from a reference product to a biosimilar during the course of a treatment is also possible and not associated with any further negative side effects compared to the reference product concerning safety or efficacy [3]. Thus, biosimilars help to reduce medication costs without any decrease in therapy quality. Therefore, the Drug Commission of the German Medical Association (Arzneimittelkommission der deutschen Ärzteschaft, AkdÄ) officially recommends the use of biosimilars [4].

Even though the acceptance of biosimilars is increasing overall, a number of doctors remain who seem to doubt substitutability and interchangeability of biologicals. Therefore, the main aim of our intervention was to increase the acceptance among physicians with a low prescription rate of biosimilars through targeted communication by phone.

Materials and methods: We analysed prescription data of doctors who participate in a contract of the Techniker Krankenkasse (TK) and the Berufsverband Niedergelassener Gastroenterologen Deutschlands e. V. (bng), which supports a safe and economical drug treatment of patients with inflammatory bowel diseases. Physicians with a prescription rate of ≤50% regarding infliximab biosimilars out of the total amount of prescribed infliximab in the second half of 2016 were selected (n=115).

In order to address the topic properly, a specific guideline was created for a personal conversation by phone. This guideline included scientific arguments to demonstrate the efficacy and safety of biosimilars in comparison with the original biologicals.

The phone call regarding the issue was announced by a cover letter which was delivered by post to the identified doctors. During the phone call the doctors found out about their individual prescription rate regarding biosimilars of infliximab. Furthermore, the doctors were asked about the specific reasons for their restrained use of biosimilars in comparison to other doctors and specific questions were answered immediately.

As the phone calls were conducted by professionals without specific medical or pharmaceutical knowledge, they were trained in advance by a pharmacist. Through this training the agents subsequently received scientific background information regarding biosimilars.

To measure the effect of our intervention, we analysed prescription data of the selected doctors one year after our initial phone calls. The main outcome measure is the number of doctors who have altered their prescribing behaviour in such a way that they reached prescription rates regarding biosimilars of infliximab of more than 50 % in the third and/or fourth quarter of 2017.

Results: The evaluation of the second half of 2017 revealed that, compared to the second half of 2016, 45% of the doctors reached the target rate of more than 50% (Figure 1 [Fig. 1]).

Furthermore, another 21% of the selected doctors improved their biosimilar rate over the target of 50% either in the third or in the fourth quarter of 2017 (Figure 1 [Fig. 1]).

Consequently, 34% did not reach the target rate (Figure 1 [Fig. 1]). However, out of those doctors only 9% were not affected by our call and refused to use infliximab biosimilars at all.

Moreover, our impression is that some doctors appreciate the individual conversation and the possibility to directly address questions or share their point of view with us.

Conclusion: Overall, our intervention shows that an individual conversation is successful to enhance economical drug prescribing and increases awareness regarding the significance of biosimilars. We conclude that within a personal conversation the issue can be addressed and discussed properly. The observed positive effect of our intervention is a notable step regarding the challenge of continuously increasing costs for expensive drugs like biologicals.