In 2010, the Assistance Direction of Pharmaceutical Management (ADPM) introduced a strategic approach to improve the uptake of biosimilars in Madrid. As a result, a Contract Plan with the hospitals in the region with incentives for prescribing and dispensing biosimilars was introduced. In 2014, the indicator %Biosimilar Drugs Cost Value, was included and in 2016 the percentage of patients on infliximab biosimilar (new patients) was included.

As a result of the work by MHS, the %Biosimilar Drugs Cost Value* improved from 15.72% in 2014 to 20.07% in 2015. It is important to note that this value could be higher if only drugs that have biosimilar versions were taken into account (somatropin, filgrastim, epoetin), instead of the whole group (somatropin, colony-stimulating factors and erythropoiesis stimulating agents) according to the indicator definition:

%Biosimilar Drugs Cost Value = Purchase cost of biosimilars of somatropin, erythropoietin or filgrastim/purchase cost of all brands of somatropin, all brands of erythropoiesis stimulating agents or all brands of colony-stimulating factors

This indicator shows wide variation between different hospitals. Several hospitals had no patients using biosimilars in 2014 (0%) compared to other hospitals with use of biosimilars around 60–70%.

Large variation is also observed in the impact of biosimilars in different types of hospitals. In ‘large hospitals’, which are large and highly complex, the percentage of biosimilars measured on this basis accounted for less than 15% whereas in ‘medium size I hospitals’, which have a medium number of beds and a medium-to-low complexity level, biosimilars reached nearly 30%. The highest average value (more than 35%) was for the ‘medium size II hospitals’ group, which also have a medium number of beds and medium-to-low complexity level, but a different management system. A table showing the individual results per hospital can be viewed in the GaBI Journal manuscript [1].

In the first year of monitoring of patients using biosimilar infliximab, it was found that  biosimilars were more frequently used on new patients starting infliximab therapy rather than patients that switched therapies.

In the experience of the authors the Contract Plan has been an effective way to transfer the Regional Health System’s objectives to the hospitals. In addition, the indicators have been a useful tool to track usage, to compare different hospitals to each other, to evaluate trends over time and to obtain results.

The information integration system permits a full picture of the use of biosimilars, their impact and their evolution over time. However, the authors are still conscious that the calculation of some indicators involves additional work for the hospitals. Therefore, the improvement of the information flow system remains an important objective to be achieved in order to reduce the workload on hospitals.

Acknowledgement
This article is prepared based on the paper entitled ‘Best practice to improve biosimilars uptake: the experience of Madrid, Spain’ by Aranguren Oyarzábal A, López Centeno B, Alonso Castro V, Calvo Alcántara MJ, Cruz Martos E, Assistance Direction of Pharmaceutical Management, Madrid Health Service, Spain

Editor’s comment
Readers interested to learn more about market uptake of biosimilars are invited to visit www.gabi-journal.net to view the following manuscript published in GaBI Journal:

Product naming, pricing, and market uptake of biosimilars

Readers interested in contributing a research or perspective paper to GaBI Journal – an independent, peer reviewed academic journal – please send us your submission here.

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Reference
1. Derbyshire M. Improving biosimilars uptake: experience gained in Madrid, Spain. Generics and Biosimilars Initiative Journal (GaBI Journal). 2016;5(2):89-91. doi:10.5639/gabij.2016.0502.021

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