Despite the implementation economic incentives across Europe, the study reports that the adoption of biosimilars is below expectations. These biological products, if adopted, can offer a route to more affordable treatment of various conditions. The authors, who are based at the University of California, Berkeley in the US, set out to determine the role of behavioural factors such as citizens’ trust in one another (social trust) and trust in government policymakers (political trust), when it comes to biosimilar adoption.

The study by Professor James C Robinson presented data on biosimilar adoption from provinces in Italy and Germany in 2020 (Figures 1 and 2). The authors used historical metrics based on various factors to code for social trust in Italy and Germany. Political trust was coded using the Quality of Government Index (QGI). 

The study included data on two biologicals used to treat chronic immunological conditions and three biologicals for acute cancer treatment, and their 20 biosimilars. Multivariable methods were used to ascertain the association between adoption, social trust, political trust and income per capita.

Overall, it was seen that the adoption of biosimilars was much lower in regions suffering from low social trust and low trust in government. The author emphasized that penetration fell below the national median in seven out of eight provinces in southern Italy and in all seven provinces in eastern Germany. Robinson stated that rates of adoption are 21.5 percentage points higher in northern than in southern Italy and 5.2 points higher in western than in eastern Germany. 

The author concludes that the study highlights the important role of social trust and trust in government when it comes to having trust in experts and institutions. In regions of Italy and Germany with historically disadvantaged populations, there are lower levels of trust and consequently lower levels of biosimilar uptake, this is thought to be because they are less inclined to believe they will benefit from budgetary advantages. It is suggested that incentives for biosimilar uptake need to be redesigned in such regions in a way that might enhance social and political trust.

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Reference
1. Robinson JC. Social trust and regional variation in the adoption of biosimilars in Italy and Germany. Generics and Biosimilars Initiative Journal (GaBI Journal). 2022;11(3):87-8. doi:10.5639/gabij.2022.1103.015

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