Introduction We instituted a biosimilar switch programme in September 2015 in adult IBD patients. Predicted cost savings were used to recruit a dedicated IBD nurse and pharmacist who supervised the switch and reviewed and updated pathways for administration of biologicals. Their appointments allowed completion of point of care assessments, standardised monitoring of drug levels and facilitated a switch from on site vial reconstitution of infliximab to pre-ordering of pre-filled bags.
The aim of this study was to assess the impact of the IBD nurse and pharmacist on patient management, patient satisfaction and pharmacy costs.
Method Data were reviewed over a 16 month period from the start of the biosimilar switch programme to the end of December 2016. As part of the programme, enhanced monitoring of patients including completion of disease activity scores (HBAI and SCCAI) and Patient Recorded Outcome (PRO) was performed at each infusion. Data were contemporaneously recorded. Patients were asked to complete a satisfaction questionnaire 6 months after they switched to biosimilar infliximab. Pharmacy records were interrogated and cost savings estimated using standard NHS salary and procurement costs.
Results Over the review period 235 patients received infliximab. A total of 1182 HBAI and SCCAI assessments and 1115 PROs were completed and infliximab levels and dosing were monitored prior to each infusion. 74/235 (31%) of patients had their treatment altered as a direct result of these assessments with 60 patients having their infliximab dose or dose interval altered and 14 patients switching to an alternative biological.
71 patients completed the satisfaction questionnaire. All were pleased (11%) or very pleased (89%) with their overall standard of care. Patients thought that their standard of management was the same (60%), better (20%) or much better (20%). They reported that their disease activity was the same (68%), better (26%) or much better (6%).
Estimated cost savings from switching from on site vial reconstitution of infliximab to ordering pre-filled bags totalled £4280 over the review period as a result of staff time saved and reduced consumable costs. Additional review of pharmacy records identified incorrect drug charging with a subsequent refund of £12 000 to the Trust.
Conclusion Integration of a dedicated IBD nurse and pharmacist into the infliximab infusion service as part of a switch to biosimilar infliximab has helped achieve a responsive service with excellent patient satisfaction measures. It also achieved cost savings over and above those expected from the switch from originator to biosimilar infliximab.
Disclosure of Interest None Declared
- cost effectiveness
- Inflammatory Bowel Disease
- nurse led
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