ESMO Congress 2023 | OncologyPRO

Abstract 1726P

Background

The rising costs of innovative oncology agents is a global challenge. In Ireland, despite rising per capita spending, access to new agents is delayed compared to other European states. A strategy to optimise existing drug spending nationally in not in place. We aimed to review how existing prescribing in a cancer centre could be optimised to accelerate access to new agents.

Methods

We performed a retrospective review of expanded access programmes (EAPs, 2011-21, 3 hospitals) and biosimilar use (2020-22, 4 hospitals) within the southwest of Ireland, and a review of clinical trial availability nationally (2022). We surveyed oncology patients receiving treatment in 3 centres, and healthcare professionals (HPCs) nationally on their view on barriers to biosimilar integration (survey 1, 2020-22) and other potential mechanisms of cost optimisation (survey 2, 2023).

Results

Our review found 193 patients accessed EAPs over 10 years (33 agents, 50 indications & 189 programmes). No national database to ensure equity of access was in place; an increasing trend of availability over time was noted. Immune checkpoint inhibitors (55%); targeted therapies (35%) and antibody drug conjugates (6%) were available through EAPs, treating lung (28%), breast (17%) and ovarian (9%) cancers. Of the 287 patients accrued to clinical trials in 2022, 48% participated in immunotherapy trials. Biosimilar use of trastuzumab and rituximab ranged from 39-100%, and 0-89% respectively among 4 hospitals. Cost savings by using biosimilars compared with reference products ranged from 28% to 73%. Table: 1726P

Results of surveys on (1) barriers to biosimilar use & (2) other methods of optimisation

Survey 1	Patients (n=16)	Pharmacists (n=205) & students (n=33)	Doctors (n=11) & students (n=64)
Biosimilar awareness	37% (n=61) ^†	97% (n=231) ^†	45% (n=34) ^†
Agreeableness to biosimilar switching	85% (n=141)	N/A	N/A
Support pharmacist-led biosimilar substitution	N/A	37% (n=87) ^†	9% (n=7) ^†
Support consistent nomenclature of biosimilars	N/A	84% (n=200)	80% (n=60)
Survey 2	Patients (n=53)	HPCs (n=60)
Support split fill dispensing initially	82% (n=42)	75% (n=45)
Support split fill dispensing long term	60% (n=28)^†	30% (n=18)^†
Support redispensing unused oral agents	29% (n=14)*	22% (n=13)*

*p<0.05, ^† p<0.01

Conclusions

Multiple disparate mechanisms are in place to optimise drug costs. We found biosimilar use and split fill dispensing was acceptable to both patients and HCPs but the majority of HCPs do not approve of pill sharing. Additional optimisation could occur through prioritisation of biosimilar substitution and education of prescribers on their benefits, a national registry of EAPs, expansion of clinical trial portfolios, and modified drug dispensing.