Patient attitudes and understanding about biosimilars: an international cross-sectional survey

Figures & data

Table 1 Respondents

	US, n					European Union, n
	Diagnoseda	Diagnosed advocacyb	Caregiverc	General populationd	Total	Diagnoseda	Diagnosed advocacyb	Caregiverc	General populationd	Total
General population	0	0	0	250	250	0	0	0	499	499
Inflammatory diseases
Inflammatory bowel disease	147	54	26	0	227	240	60	50	0	350
Rheumatoid arthritis	150	52	25	0	227	241	60	50	0	351
Psoriasis	150	50	25	0	225	240	60	51	0	351
Total inflammatory diseases	447	156	76	0	679	721	180	151	0	1,052
Oncology
Breast cancer	76	16	7	0	99	120	15	13	0	148
Lung cancer	53	27	7	0	87	60	14	10	0	84
Non-Hodgkin’s lymphoma	19	20	10	0	49	24	11	10	0	45
Hodgkin’s lymphoma	5	10	4	0	19	24	13	10	0	47
Colorectal cancer	35	16	7	0	58	60	12	10	0	82
Total oncology	188	89	35	0	312	288	65	53	0	406
Overall total	635	245	111	250	1,241	1,009	245	204	499	1,957

Notes:

a Diagnosed with inflammatory bowel disease including Crohn’s disease and ulcerative colitis, rheumatoid arthritis, or psoriasis (moderate to severe only) for ≥6 months and had seen the doctor in past 12 months about the particular condition, or have had breast cancer, lung cancer, colorectal cancer, or non-Hodgkin’s lymphoma in past 2 years.

b Diagnosed with any of the listed diseases and had heard of and participated in patient support groups.

c Has a loved one with any of the listed diseases and is involved in decisions or dialogue about medication or therapy options.

d Individuals aged 18–64 years without any of the listed diseases or loved ones with these conditions.

Table 2 Awareness and current use of biologic therapies and biosimilars

	US, %			European Union, %
	General populationa n=250	Diagnosedb n=635	Diagnosed advocacyc n=245	General populationa n=499	Diagnosedb n=1,009	Diagnosed advocacyc n=245
Biologic therapy
Awareness^d,e
Has at least a general impression	11	30A	47^A,B	10	19A	43^A,B
Just know the name	16	19	31^A,B	17	26A	29A
Not sure	17	17C	12	22^B,C	18	15
Never heard of it	57^B,C	33C	10	50^B,C	37C	12
Currently use	N/A	18	29B	N/A	9	31B
Biosimilar therapy
Awareness^d,e
Has at least a general impression	6	9	20^A,B	6	11A	30^A,B
Just know the name	10	16A	27^A,B	10	19A	31^A,B
Not sure	14	21A	23A	19	22	19
Never heard of it	70^B,C	54C	31	66^B,C	49C	20
Currently usef	N/A	2	9B	N/A	5	22B

Notes:

a Aged 18–64 years without any of the listed diseases or loved ones with these conditions.

b Diagnosed with inflammatory bowel disease including Crohn’s disease and ulcerative colitis, rheumatoid arthritis, or psoriasis (moderate to severe only) for ≥6 months and had seen their doctor in past 12 months about the particular condition, or who have had breast cancer, lung cancer, colorectal cancer, or non-Hodgkin’s lymphoma in past 2 years.

c Diagnosed with any of the listed diseases and had heard of and participated in patient support groups.

d Defined as reporting at least a general impression of biologics or knew the term “biologic” or “biosimilars”.

e Not all categories sum to 100% due to rounding.

f Use could include during participation in clinical trials at the time of the survey.

A P<0.05 for the column proportions test in comparison to the general population group in the same region.

B P<0.05 for the column proportions test in comparison to the diagnosed group in the same region.

C P<0.05 for the column proportions test in comparison to diagnosed advocacy group in the same region.

Abbreviation: N/A, not applicable.

Figure 1 Gaps in perceptions about biosimilars among patients aware of and those unaware of biosimilars.

Notes: *Unaware = answered “never heard of biosimilar” in response to the question, “Which of the following types of medications have you heard of before today?” No statistical analyses were conducted between patients aware and those unaware of biosimilars.
Abbreviations: EU, European Union; pts, patients.

Figure 2 Gaps in perceptions about biosimilars compared to biologic therapies among patients aware of biosimilars.

Note: No statistical analyses were conducted between groups.
Abbreviations: EU, European Union; pts, patients.

Table 3 Checklist for health care providers of the information needed for patients to make informed decisions about biosimilar use/health care

Discussed with patient?	Topic
	Use of biologic therapies in the specific disease
	Definition of a biosimilar
	Totality of evidence required of a biosimilar
	Efficacy similar to innovator biologic
	Safety similar to innovator biologic
	Delivery/administration of the agent
	Device use (if applicable)
	Access to treatment
	Insurance coverage and out-of-pocket cost
	Services available to support the patient
	Clinical trials including standard biosimilar trial design (active innovator comparator; no placebo arm)
	Manufacturer identity

Figure S1 Approval process for biosimilars.

Table S1 Demographics

	US, n				European Union, n
	Diagnoseda	Diagnosed advocacyb	Caregiverc	General populationd	Diagnoseda	Diagnosed advocacyb	Caregiverc	General populationd
Sex, %
Male	35	37	44	49	46	53	47	47
Female	65	63	56	51	54	47	53	53
Mean age, years, %e	52.9	45.8	48.7	41.9	39.6	44.7	42.7	43.8
18–24	4	6	5	13	5	9	6	8
25–34	15	24	24	21	22	33	22	17
35–44	14	19	14	18	24	27	29	26
45–54	19	18	15	26	23	17	26	26
55–64	27	22	24	22	18	11	13	23
65–74	15	9	14	0	7	2	4	0
75+	5	2	4	0	1	0	0	0
Country, %e
USA	100	100	100	100	0	0	0	0
UK	0	0	0	0	27	26	16	20
France	0	0	0	0	17	14	25	20
Germany	0	0	0	0	18	21	13	25
Spain	0	0	0	0	17	16	26	15
Italy	0	0	0	0	20	23	21	20

Notes:

a Diagnosed with inflammatory bowel disease including Crohn’s disease and ulcerative colitis, rheumatoid arthritis, or psoriasis (moderate to severe only) for ≥6 months and had seen the doctor in past 12 months about the particular condition, or have had breast cancer, lung cancer, colorectal cancer, or non-Hodgkin’s lymphoma in past 2 years.

b Diagnosed with any of the listed diseases and had heard of and participated in patient support groups.

c Has a loved one with any of the listed diseases and is involved in decisions or dialogue about medication or therapy options.

d Individuals aged 18–64 years without any of the listed diseases or loved ones with these conditions.

e Not all categories sum to 100% due to rounding.