Equity, expense, and expertise in biologic commissioning: adding the patient to the equation

ABSTRACT

Introduction

Immune-mediated inflammatory diseases (IMIDs) are increasingly managed effectively with biologic medicines. However, with relatively high unit costs, there remains a meaningful pressure to ensure streamlined, equitable, and inclusive prescription of biologics in the UK. Despite an increased awareness of the benefits of patient-centric shared decision making, patients remain on the periphery of biologic selection for the treatment of IMIDs.

Areas covered

We provide a patient perspective on core issues in the commissioning, prescription, and decision making around biologics for IMIDs in the UK, focusing on England. In particular, the crucial aspect of determining ‘value’ for different stakeholders, who necessarily have different priorities, is considered.

Expert opinion

There are disparities in commissioning, access to, and prescription of biologics for IMIDs in the UK. This creates an unequal treatment model and drives patient dissatisfaction with an ‘experience lottery’ for the management of disease. A more transparent approach to prescribing decisions, made in close consultation with patients, is essential for improving equity and experience with biologic treatment of IMIDs.

KEYWORDS:

• Biologics
• immune-mediated inflammatory diseases (IMIDs)
• inclusion
• joint decision making
• pathways
• patient-centric
• treatment equity

Article highlights

• In the UK, commissioning of local healthcare services has a key influence on medicine prescribing. The recent move to an integrated care system model provides an opportunity to end the segregation of primary and secondary care pathways, and feature patient-centric decision making.

• Integration of care pathways can help to address biologic prescribing decisions being made in isolation from routine disease management.

• Understanding a patient’s determination of the value of treatment is essential in making informed treatment decisions for immune-mediated inflammatory diseases (IMIDs).

• By bringing together integrated pathways, transparency in prescribing decisions, understanding of stakeholder perceptions of treatment value, and encouraging patient health literacy, meaningful steps can be taken toward minimizing the ‘experience lottery’ and improving treatment access and outcomes in the management of IMIDs.

Abbreviations

CCG, clinical commissioning group; COVID-19, coronavirus disease 2019; DLQI, Dermatology Life Quality Index; DMARD, disease-modifying anti-rheumatic drug; GP, general practitioner; HCP, healthcare professional; HM, Helen McAteer; IBD, inflammatory bowel disease; ICS, integrated care system; IMID, immune-mediated inflammatory disease; NASS, National Axial Spondyloarthritis Society; NHS, National Health Service; NICE, National Institute for Health and Care Excellence; PASI, Psoriasis Area and Severity Index; PROM, patient-reported outcome measure; PsA, psoriatic arthritis; PsAID-12, 12-item Psoriatic Arthritis Impact of Disease Questionnaire; RCT, randomized controlled trial; ST, Seb Tucknott.

Declaration of interests

S Tucknott is an employee (Chief Executive) of IBDrelief Ltd. This organization has received grants and funding from AbbVie, AstraZeneca, Bristol Myers Squibb, Eli Lilly, Galapagos, Janssen, Norgine, PredictImmune, Roche, and Takeda. H McAteer is an employee (Chief Executive) of the Psoriasis Association (charity registered in England and Wales [charity number: 1180666] and in Scotland [charity number: SC049563]). Over the past 36 months, this organization has received funding from AbbVie, Almirall, Amgen, Eli Lilly, Janssen/Janssen-Cilag, LEO Pharma, Novartis, and UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to acknowledge the input of Dale Webb (NASS, London, UK) into the discussions that led to this manuscript. Helen McAteer acknowledges the support and input of Laura Stevenson (Deputy Chief Executive, Psoriasis Association, Northampton, UK). Medical writing support was provided by Natalie Griffiths, PhD, of OPEN Health Communications, London, UK; Colin Griffin, PhD (Griffin Scientific Ltd., Hereford, UK), on behalf of OPEN Health Communications, London, UK; Charles Geary, MSci, of OPEN Health Communications, London, UK; and Ellie Hughes, PhD, of OPEN Health Communications, London, UK, and funded by Janssen-Cilag Ltd., in accordance with Good Publication Practice guidelines (https://ismpp.org/gpp-2022).

Additional information

Funding

The planning and delivery of this project was funded by Janssen UK. The sponsor was not involved in the discussions presented in this manuscript.