Biosimilar G-CSF
Implementation & lessons learnt
Kashyap Thakrar
Lead Formulary & Medicines Management Pharmacist
University College London Hospitals (UCLH), London, UK
Presentation
 My role
 G-CSF pan-London therapeutic tender
 Therapeutic rationalization
examples
 Implementation strategy
 London Procurement Plan (LPP)
 Overcoming resistance
 NCL JFC
 Results & Benefits
 Barriers to implementation
 Look to the future
Q&A
My role
 Lead F&MM Pharmacist, UCLH
 DTC & NCL JFC
 Formulary
 QIPP
 Competitive tenders, branded medicines
 Publications
 Editor UCL Injectable guide
 MSc Health Economics
QIPP = Quality, Innovation, Productivity and Prevention
 Role of NICE (National Institute for Health & Care Excellence)
 NICE Technological appraisal
 Biosimilar statement
 Role of local DTCs
 JFCs
 Local formularies
 QIPP
 Re-imbursement of medicines
NHSE = National Health Service England
JFC = Joint Formulary Committee
DTC = Drugs & Therapeutics Committee
Re-imbursement of medicines
Medicine
In-tariff
Local hospital
NHSE = National Health Service England
Ex-tariff
NHSE
CCGE = Clinical Commissioning Group
Local
CCG
London procurement
programme
London procurement programme
 £5.5 billion spend on goods and services*
 £2 billion on medicines
= 20% of total England & Wales spend
 15% annual inflation on medicine expenditure
• Driven by new high-cost medicines and innovations
 Budgets capped
 Work with Trusts: £27 million saved on medicines alone in 4 years
Royal Marsden Hospital
Guy’s Hospital
University College Hospital
St Thomas’ Hospital
Royal Free Hospital
King’s College Hospital
Therapeutic rationalization
Therapeutic rationalization ideas
Angiotensin II receptor blockers (ARBs)
Botulinum A toxins
Human growth hormones – Biosimilar Omnitrope®
Therapeutic
rationalization
GCSF – Biosimilar Zarzio®
Epoetins – Biosimilar Binocrit®
Infliximab - Biosimilar ®
Systemic antifungals
Tissue sealants
GCSF pan-London
therapeutic tender
GCSF therapeutic tender
 Competitive market
 High-cost high-volume products
 Pre-meet with all suppliers
 Therapeutic tender
 Matrix-based tender
 No local deals!
Implementation strategy
Implementation strategy
Communication
Local assistance & protocol change
Monthly tracking
Implementation
RAG rating and hierarchical standings
Identifying and learning from model Trusts
Targeting poor performers
Cost savings data
Barriers to implementation
Barriers to implementation
 Requirement for local-decision making
 Clinical data “push-backs”
• Data 1: Biosimilar misinformation
• Data 2: Healthy volunteers
• Data 3: Stem-cell mobilisation
• Data 4: Neulasta® and febrile neutropenia rates
 Neulasta® convenience (and perceived cost) advantage
 Originator support
 Lack of (hospital) financial incentives
 Electronic prescribing protocols (Chemocare)
Chemocare® protocol changes
Overcoming resistance
Overcoming resistance
NHS-industry
partnership working
One Neulasta® injection –
niche position retained,
Zarzio® -support package 6
Lack of (hospital)
financial incentives –
gainshare arrangements
2
1
Overcoming
resistance
5
Data: Detailed evidence-based
stakeholder discussions, costminimisation analysis of
Zarzio® vs. Neulasta®
3
4
Originator support –
identification and
channelling of savings
Electronic prescribing
protocols – master
protocol change/support
Results
Implementation of daily G-CSF therapeutic
tender (1): Zarzio® vs Granocyte®
Implementation of daily G-CSF therapeutic
tender (2): Zarzio® vs Granocyte®
UCLH daily GCSF Volumes
1600
1400
1200
1000
Zarzio
800
Granocyte
600
400
200
0
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Implementation of G-CSF
therapeutic tender: long-acting (Neulasta®)
Implementation of daily G-CSF (2): Zarzio® vs
Neupogen® vs Granocyte® Volumes
London implementation of
daily G-CSF tender (1): Savings
£1 000 000 annual net save
despite increased usage
£3.3
million
£2.3
million
£3.5 million cost save
achievable if 100% daily
G-CSF & 80% Neulasta®
switch to Zarzio®
London implementation of G-CSF
therapeutic tender: long-acting (Neulasta®)
NHS London Pegfilgrstim Volum es
900
850
800
750
700
650
600
550
500
450
400
Mar12
Apr12
May12
Jun- Jul-12 Aug12
12
Sep12
Oct12
Nov12
Dec12
Jan13
Feb13
Mar13
Apr13
East of England implementation
Rapid uptake of biosimilar G-CSF in UK
• Biosimilar G-CSF has 83%
volume share1
• 40% increase in daily G-CSF
volume usage since biosimilars
launched2
• Clinicians are beginning to see
the benefit of reduced costs to
reinvest in novel cancer therapies
1
IMS, Dec 2011; 2 IMS, Sept 2008 vs Dec 2011
Cost-savings through use of biosimilar G-CSF
Annual savings achieved by London
hospitals after switch to Zarzio®
£2 000 000
(AUD 3 200 000)
Estimated annual savings to
European
healthcare system
€85 000 000
Benefits
Benefits
Benefits
1
Deliver against QIPP targets
2
Used to offset against workforce saving pressures
3
Increase access to new cancer therapies
4
Increase access to G-CSF
Q&A