Highlights
- •Insulin glargine is a costly antidiabetic medication.
- •The use of biosimilars helps optimize healthcare spending.
- •BC announced a coverage policy requiring patients to switch to biosimilar insulin.
- •Rapid monitoring of healthcare services was implemented.
- •The monitoring detected only expected or transient impacts on utilization.
Abstract
Purpose
This study monitors for early changes in health services utilization after a mandatory
policy to switch patients from originator to biosimilar insulin glargine in British
Columbia, Canada.
Methods
We conducted a prospective cohort study of patients treated with originator insulin
glargine. The policy cohort included patients treated with originator insulin glargine
in the 6 months before the policy change (May 27, 2019). Three historical control
cohorts included users of originator insulin glargine during the 6 months before May
27 each year in 2016, 2017, and 2018. Patients who discontinued or switched use of
the originator insulin glargine and those without cost coverage by the provincial
drug plan were excluded. Using likelihood ratios, we compared the daily use of medications,
outpatient visits, and hospitalizations in the 12 months after the policy change with
the daily use in 3 historical control cohorts. A sustained likelihood ratio above
a predefined threshold of 7.1 was interpreted as an early signal of a possible policy
impact.
Findings
Each cohort included 15,344 to 17,310 patients. In the first year of the policy, we
observed increases in (1) insulin glargine use (the cumulative incidence increased
by 2.5% compared with the mean of the 3 historical cohorts), (2) oral antidiabetic
medication use (increased by 2.8%), and (3) outpatient visits (increased by 1.4%).
Likelihood ratios greater than the threshold of 7.1 were detected for these 3 outcomes.
Implications
We observed marginal changes in health services utilization without detecting signals
of negative health impacts on patients targeted by the British Columbia policy of
mandatory switching from originator to biosimilar insulin glargine.
Key words
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Article info
Publication history
Published online: June 09, 2022
Accepted:
May 5,
2022
Identification
Copyright
© 2022 Elsevier Inc.
