So this is a subject that you no doubt will see featured heavily on this site. After all, it was my forced switch from Humira to Imraldi and the months of poor health that followed, that inspired me to start this blog. See blog post ‘The inception‘.
Is too much emphasis placed on the cost of care?
In this post we ask what about the patient when enforcing treatment changes to save money?
I came across this article today from Guyon Espiner of Radio New Zealand:
It’s a story about how at least three people in New Zealand with epilepsy have sadly died since a drug brand switch in a bid to save $30m.
The similarities with what the NHS did with biologics are obvious. (See: https://joelvsarthritis.co.uk/nhs-biologic-switch-articles-2018/) However, there are two questions that keep coming to mind every time I read these stories:
- Why are healthcare provider decision makers changing the more expensive drugs or treatments that are working. Rather than focusing on ineffective treatments or those requiring numerous branches of secondary care/support?
- Why is everything done with a ‘big bang’ approach rather than a phased switch? Why not start with those patients with less-severe varieties of a condition, those at less risk etc.
I can’t talk about the epilepsy situation in NZ as apart from reading a handful of articles on the matter, I’m not well informed enough or qualified to have an option. So I will discuss this in the case of my switch from Humira to Imraldi in January of 2019.
Don’t touch what isn’t broken
My first question is probably a simple case of money. Healthcare leaders are looking for savings and efficiencies and those big-ticket drugs are the obvious choice. But this is short sighted. For example, in my case they might have saved a few hundred pounds per injection, per patient a month but what about all my hospital and GP visits since the switch? Or the almost instant flare-up? The physio, increased reliance on pain relief, steroid injections, new anti inflammatories to try and stem the tide, blood tests etc. Not to mention the wider impact with significantly increased absence/time off work?
Suddenly that big number they are looking to save has started to be chipped away at and I am just one patient out of thousands that experienced adverse effects, flares or a general decline in health post-switch.
Apply some common sense when implementing such changes
The second question I have less sympathy for. I understand it’s probably a contractual matter and healthcare providers don’t want too much of an overlap when switching drugs or products to a new provider. However, in the case of the NHS biologics change to biosimilars, the pace of implementation of the change was frightening; borderline dangerous.
Let me give you my personal timeline of the experience.
The announcement for the switch to biosimilars was made by the NHS in Oct-Nov 2018. I was told by my doctors that I was switching in January 2019. By February 2019 I had already had the first injection of the new drug.
At the time, I was perfectly healthy, playing rugby, cycling and weighed less than twelve stone. By the end of 2019? I was unable to run, cycle or play sport, walking with a limp and just shy of 14 stone. I had also had around three months off work through pain or complications of the disease. Today, I still rely on daily painkiller medication to get through the day.
From what I’ve been told by clinicians, this approach was taken for virtually everybody. The CCGs couldn’t move to save money quick enough. So when the problem hit, everybody suffered. GPs, walk-in centres, Rheumatology Depts, physios etc. The fact that I wasn’t able to get access to physio or hydrotherapy (the two go-to approaches for years whenever I flare) for the entire 10-11 months of this issue, told me the pressure those services were under from the influx.
For the sake of safety, wider healthcare services, people’s jobs, mental wellbeing, families and livelihoods; why isn’t a phased, more considered approach insisted upon for these drug changes? Especially when finance appears to be the key driver in these changes rather than a patient’s treatment plan or clinical reasons. I very much doubt long term, there’s much money saved when you factor in the pressure people such as me have since placed on the system.
I am still being hit by the ripples of that change. What may have seemed like a drop in the ocean to those decision makers. A meer £5m saved, has turned my world upside down. It has also tarnished the first year with my son (also born in January 2019). For that, I don’t think I can ever forgive those behind that decision.
Has this switch from biologics to biosimilars impacted you? Are you a medical professional that would like to share an opinion on this subject? If so, then we’d love to hear from you.