Improving the Transition to Biosimilars: The Influence of Communication Strategies, Companions and Patient Concerns

Abstract

Biopharmaceuticals (biologics) have revolutionised the treatment of immune-mediated inflammatory diseases but created a significant financial burden for healthcare systems globally. Biologics are large molecule medicinal products that derive from living organisms. While patients are often transitioned from original biologics (bio-originators) to biosimilars to reduce cost and improve access, patient resistance and hesitancy have dampened their uptake. To date, it is unclear how to communicate the transition to ensure patients accept biosimilars. Patients are also frequently accompanied to consultations by companions who may influence patients’ expectations and decisions. This thesis intends to understand how the transition to biosimilars can be improved. Specifically, it explores how communication strategies can increase patient acceptance of biosimilars and aims to determine and augment the involvement of companions in decisions about changing to biosimilars. Through this research, this thesis provides a rationale for using health psychology theory in future research on biosimilar acceptance. The thesis comprises of two main sections. The first section provides insight into how communication can be improved to increase patient acceptance. A systematic review with a meta-analysis was conducted to explore 33 communication strategies used globally to inform patients about biosimilars. Patient willingness to transition was found to be the highest when receiving written and verbal information, and written information that only addressed a few key concerns. Patients were primarily notified about cost savings as a reason for the brand change. However, pharmacists and other providers were rarely upskilled prior to the transition. A cross-sectional study was conducted to identify pharmacists’ readiness to educate patients before and during the early stages of the transition to biosimilar Amgevita in Aotearoa/New Zealand. The study highlighted low confidence in explaining testing and manufacturing, gaps in key knowledge, and concerns about not knowing enough to educate patients. While pharmacists require additional training and resources, they may also benefit from guidance in identifying patients who may need further reassurance or information. A correlational study was conducted to explore whether patients’ characteristics are associated with concerns about taking biosimilars and safety expectations. Patients who were female, sought information online, preferred innovator drugs, and had stronger emotional responses to their condition had more negative perceptions. The second section widens the focus to determine and augment companions’ involvement in discussions about biosimilars. In a randomised controlled trial, patients with rheumatic diseases who have companions were randomly assigned to receive information about biosimilars alone or with their usual companion. Companions did not influence patients’ hypothetical decisions to change to biosimilars or risk perceptions but did negatively impact understanding. Building on this, a pre-specified analysis was conducted to explore companions’ concerns about biosimilars. While companions and patients had similar confidence in biosimilar use and expectations towards safety, efficacy, and side effects, companions reported some unique information needs. In the last randomised controlled trial, a community sample acting as patients or companions were randomised to receive information about biosimilars by a physician using patient-only or family-centred communication. Findings suggested that family-centred communication does not further improve patients’ willingness to transition but can improve patient-provider-companion encounters. This study also showed that companions’ behaviours during consultations, such as asking questions, impact patient understanding. The research presented in this thesis is among the first to consider the application of health psychology theory and interventions to improve patient acceptance of biosimilars. In Chapter 9, it is concluded that health psychology research should be used to further understand possible mechanisms of patient resistance, and previously successful interventions should be translated to improve biosimilar acceptance. Future research in this area should further examine the interpersonal processes that occur between patients and companions during treatment deliberations and include experimental studies that explore the effects of communication in real-world transitions. The research in this thesis provides guidance on optimising communication strategies and the presence of companions, and may ultimately improve future transitions to biosimilars.