Abstract:
Introduction: Biosimilars are the nearly identical, cost-effective alternatives to bio- originators. Introducing biosimilars into the New Zealand pharmaceutical market would enable more patients to access expensive treatments. However, patients' negative perceptions and lack of acceptance have acted as barriers to their uptake internationally. Some physicians are also unsure how to explain switching to biosimilars to patients, which further restricts their use. Aim: A randomised controlled trial was conducted to investigate the effects of positive and negative framing on patient acceptance and perceptions towards biosimilars. The study also investigated the added value of using an analogy as part of the explanation. Method: Ninety-six rheumatology patients currently taking bio-originators at Greenlane Clinical Centre were randomised to receive a negative or positive framed explanation about switching to a biosimilar, with or without an analogy. Measures included willingness to switch, perceptions towards biosimilars (expected side effects, efficacy, safety, anxiety and concern about switching), efficacy of the explanation (coherence, being reassuring, convincing and important) and preferences for generics. Results: Positive framing led to more patients being willing to switch than negative framing (67% versus 46%). Positive framing also enhanced perceptions of the biosimilars efficacy (p = .046), was more convincing (p = .030) and increased preferences for generics (p = .014). The analogy did not increase willingness to switch or improve understanding (p's > .05). Patients were most concerned about efficacy (50%) and safety (46%), and wanted considerable time to discuss switching (M = 38.70 minutes, SD = 25.39). Consultation time was associated with concerns (rs = .30, p = .004), but not with preferences for biosimilars, anxiety about switching or perceptions of biosimilars (p's > .05). Most patients (74%) would use Internet searches to seek information and 76% wanted to be referred to a website. Conclusion: This is the first study to examine how switching can be explained to patients taking bio-originators. Results demonstrate that positive framing has a significant impact on the percentage of patients willing to switch, but an analogy adds little to willingness to switch. Further research should explore the influence of health literacy and wider benefits of framing on reducing nocebo responses and non-adherence after switching.