Keele Research Repository

Background: Biological medicines are effective but expensive options for treating patients with chronic and life-threatening diseases unresponsive to conventional small molecule medicines. The importance of biosimilars as an alternative to expensive originator biologics in treatment regimens is increasing year by year. This thesis aimed to examine the prescribing pattern of current marketed biosimilars and understand the potential factors influencing their prescribing in UK.

Methods: Examples of generic medicines entry were analysed and compared and contrasted with the entry of biosimilars in both primary and secondary care settings. Web-surveys were conducted with 234 healthcare professionals (HCPs) and 182 service users to investigate their knowledge and attitudes towards biosimilars. Face-to-face semi-structured interviews were then conducted with 26 HCPs and service users to further elucidate interviewee’s perceptions of biosimilars.

Results: Findings from the market analyses showed that the penetration of a generic and/or a biosimilar is governed by the cost, the number of products (competitors) and chronicity of use when the delivery devices are the same. When delivery device or another factor influencing prescribers’ perceptions of patient benefit differed, biosimilar uptake was inhibited. The findings from web surveys and interviews showed that both HCPs and service users had a good knowledge and understanding of biosimilars and their importance for cost savings. Concerns about safety and efficacy of biosimilars during the process of switching to biosimilars were expressed by HCPs and services users, although the extent of this concern varied with the clinical discipline.

Conclusion: The introduction of biosimilars is associated with considerable cost savings to the NHS. There are subtle differences between specialists’ views on biosimilars and different uptake patterns. Factors influencing prescribing biosimilar medicines were similar but more complicated than generic medicines. Cost is a key driver for the uptake of biosimilars only when patients related factors were justified or equal.