How do hospital characteristics and ties relate to the uptake of second-generation biosimilars? A longitudinal analysis of Portuguese NHS hospitals, 2015–2021

ABSTRACT

Background

There is limited evidence on within-country discrepancies in biosimilar uptake. This study analyzes differences in timing and diffusion of biosimilar uptake across Portuguese NHS hospitals and explores possible determinants.

Research design and methods

We analyzed publicly accessible consumption data of originator biologic and biosimilar drugs for adalimumab, etanercept, infliximab, rituximab, and trastuzumab, by hospital and month for the years 2015–2021 (N = 9,467). We modeled the time to biosimilar adoption using survival regression models and the share of biosimilar consumption using generalized estimated equations with random hospital effects.

Results

Academic hospitals were characterized by a quicker uptake of adalimumab and infliximab biosimilars but lower shares for other drugs. A higher total consumption of biologics was related to a lower share of biosimilar uptake. A stronger participation in randomized controlled trials was linked to higher biosimilar shares and quicker uptake, except for rituximab. If all NHS hospitals had biosimilar shares equal to the highest ones, potential annual savings could reach 13.9 million euros.

Conclusion

The findings suggest a need for capacity-building on biosimilar prescribing, including for doctors of academic hospitals and those working in settings where high biosimilar use would be expected.

KEYWORDS:

• Biosimilar
• uptake
• diffusion
• intra-country differences
• hospital-related determinants
• savings
• Portugal

Declaration of interest

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.

Author contributions

Concept and design: J Perelman, S Vogler, C Mateus. Analysis and interpretation of data: J Perelman, F Duarte-Ramos, A Gouveia, L Pinheiro, F Ramos, S Vogler, C Mateus. Drafting of manuscript: J Perelman. Critical revision of the paper for important intellectual content: F Duarte-Ramos, S Vogler, C Mateus. All authors read and approved the final manuscript for publication.

Additional information

Funding

This study was financed by an unrestricted grant by the Portuguese Association of Generics and Biosimilars (APOGEN) to the Nova National School of Public Health. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript. The funder was informed that the paper was submitted, and agreed with the submission. Authors not affiliated to the Nova National School of Public Health did not receive any funding for participating in this study.