Standardizing biosimilar adoption in oncology through the electronic health record can improve biosimilar utilization and reduce health system costs.
The standardized approach led to a 51% improvement in biosimilar utilization over the course of 1 year, with an estimated reduction in direct spending exceeding $1 million per month, reported Suwicha Limvorasak, BCOP, PharmD, Pharmacy Program Coordinator, Cedars-Sinai Medical Center, Los Angeles, CA, and colleagues in an abstract at the 2022 American Society of Clinical Oncology Annual Meeting.
The biosimilar substitution approach used across the oncology enterprise leverages the electronic health record to integrate with clinical algorithm pathways and financial information. Preferred biosimilars drugs were selected through the Oncology Pharmacy & Therapeutics Committee as part of the formulary process. Physicians were allowed to opt out of substitution within the electronic order set.
Between January and December 2021, a total of 811 patients with cancer who initiated treatment with bevacizumab (Avastin), rituximab (Rituxan), or trastuzumab (Herceptin) were identified, of whom 535 were eligible for the analysis.
Overall, substitution to biosimilars occurred at a rate of 83% (72% for bevacizumab substitution, 87% for trastuzumab substitution, and 90% for rituximab substitution) compared with a baseline of 55%. The conversion rate was higher at the main medical center compared with affiliated sites (85% vs 81%, respectively). By insurance plan, the conversion rates were 91% in health maintenance organizations, 83% in preferred provider organizations, 82% in Medicare/Medi-CAL plans, and 85% in other types.
Among 92 patients who did not have substitution to biosimilars, the most common reasons were off-label indication in 35%, patient assistance programs in 17%, payer preferred an alternate brand in 15%, and the clinician preferred the reference product in 12%. Four patients (<1%) were not converted due to infusion reactions possibly related to biosimilars. “Based on the wholesale acquisition cost, we estimate reduction in direct spending of $1.2 million per month or an average 23% cost-savings,” Dr Limvorasak and colleagues noted.
“[These] real-world data suggest that use of an integrated electronic health record to standardize biosimilar utilization in oncology may reduce costs,” they concluded. “This approach leverages existing infrastructure for successful biosimilar adoption in oncology while preserving quality and safety.”