Public deliberation to assess patient views on biosimilar medication switching for the treatment of inflammatory bowel disease

• Published in: BMC health services research Vol. 24; no. 1; pp. 1209 - 11
• Main Authors: Ryan, Kerry A, Cohen-Mekelburg, Shirley, Baker, Jessica A, Weinheimer-Haus, Eileen M, Krenz, Chris, Hou, Jason K, De Vries, Raymond, Waljee, Akbar K
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09.10.2024; BioMed Central; BMC
• Subjects: Adult; Aged; Biological products; Biosimilar pharmaceuticals; Biosimilar Pharmaceuticals - economics; Biosimilar Pharmaceuticals - therapeutic use; Biosimilar switching; Care and treatment; Decision making; Deliberative democracy; Diagnosis; Drug Substitution - psychology; Drugs; FDA approval; Female; Gastroenterology; Gastrointestinal diseases; Health aspects; Health Knowledge, Attitudes, Practice; Humans; Inflammatory bowel disease; Inflammatory bowel diseases; Inflammatory Bowel Diseases - drug therapy; Interviews; Male; Medical research; Medicine, Experimental; Middle Aged; Patient compliance; Patient education; Patient preferences; Patient-centered care; Patients; Surveys and Questionnaires; United States; United States Department of Veterans Affairs; Video teleconferencing; United States; Ann Arbor Michigan; United States > US; Inflammatory bowel disease; Patient preferences; Biosimilar switching; Deliberative democracy; Patient-centered care
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-024-11570-3

Biosimilars are highly similar, but not identical, versions of originator biologic medications. Switching patients to biosimilars presents an opportunity to mitigate rising drug costs and expand patient access to important biologic therapies. However, decreased patient acceptance and adherence to biosimilar medications have been reported, which can lead to loss of treatment response, adverse reactions, and inefficient resource utilization. Understanding patient perceptions of biosimilars and biosimilar switching is needed to inform patient-centered care strategies that promote efficient resource utilization. We used democratic deliberation methods to solicit the informed and considered opinions of patients regarding biosimilar switching. Patients with inflammatory bowel disease (IBD; n = 29) from the Veterans Health Administration (VHA) participated in 5-hour deliberation sessions over two days. Following educational presentations with experts, participants engaged in facilitated small group discussions. Transcripts and facilitators' notes were used to identify key themes. Participants completed surveys pre- and post-deliberation to collect sociodemographic and clinical features as well as to assess IBD treatment knowledge and attitudes toward care and approaches to biosimilar switching. Five major themes emerged from the small group discussions in the context of biosimilar switching: 1) concerns about adverse consequences and unclear risk-benefit balance; (2) importance of communication and transparency; (3) desire for shared decision making and patient involvement in treatment decisions; (4) balancing cost-saving with competing priorities; and (5) advocating for individualized care and prioritization based on risk levels. These views led participants to favor approaches that prioritize switching the sickest patients last (i.e., those with poorly controlled disease) and that offer patients control and choices around biosimilar switching. Participants also expressed preferences for combining elements of different approaches to maximize fairness. Approaches to biosimilar switching should consider patients' desires for transparency and effective communication about biosimilar switching and engagement in their medical decision-making as part of patient-centered care. Incorporating patient preferences around biosimilar switching is critical when navigating the quality and affordability of care in resource constrained settings, both within the VHA and in other healthcare systems.