AB1337\u2005A VIRTUAL BIOLOGIC PATHWAY TO IMPROVE CARE STANDARD, REDUCE TREATMENT DELAYS AND IMPROVE COST EFFICIENCY - THE WHIPPS CROSS VIRTUAL BIOLOGIC CLINIC EXPERIENCE

Abstract

Background Biologic therapies have become standardised as best practice for treatment of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Axial Spondyloarthopathies (AS) in the UK. There are more stringent criteria for access versus Europe and the USA. There is no agreed mechanism to choose a specific agent over and above locally agreed criteria that are disease specific. Most UK rheumatologists make an individual decision based on personal experience and guidelines as well as evidence. There are cost implications and inherent delays within locally agreed pathways that involve a pharmacist and a patient education process that may be nurse led. The overall process to initiate this treatment takes months. To this end a weekly one hour Virtual Biologic Clinic (VBC) has been set up: attended by the multi-disciplinary team of all consultants, clinical and research nurse specialists, lead pharmacist and an administrator. Objectives We compared waiting time for biologic initiation before and after the VBC, assessed numbers whose treatment plan was altered and we attempted a cost analysis. Methods All patients with RA, PsA, AS and a relevant connective tissue disease (CTD) attending VBC between Nov 2017 and Jun 2018 were included in this retrospective observation. All patients starting a biologic therapy one year earlier (Nov 2016-17) were compared. The time between decision to treat and prescription receipt by delivery company/day unit (for IV admin) was measured (by Mann-Whitney U test) in both groups. In the VBC group time between decision to treat until funding approval obtained was measured and overall saving by all estimated drug cost was calculated. Results 122 patients were discussed at VBC - 75 started a biologic (50 new, 25 switched) and 6 entered a clinical trial. The remaining 41 were agreed as unsuitable for a biologic table 1.Table 1 Patient not suitable for biologics through VBC IFR: individual funding requests, cDMARDs: Conventional disease modifying ant rheumatic drugs. Reasons for not receiving biologic (n=41) % IFR application (rejected) 6 12.1% Patient factor* 5 12.1% Disease activity not meeting NICE criteria 22 53.60% Alternative treatment offered (eg: cDMARDs) 6 14.60% Other ** 2 4.8% *1 recurrent infection, 3 did not do their screening test, 1 did not do the recommended vaccination. **1 relocated, 1 was referred to gastroenterology team *1 recurrent infection, 3 did not do their screening test, 1 did not do the recommended vaccination. **1 relocated, 1 was referred to gastroenterology team Comparing groups 69 patients (missing data = 6) waited an average of 35 days (median 27 days) to start a biologic vs 105 average days (median 85) pre VBC for 120 patients (U is 1033, p-value is < .00001 two tailed). In the VBC group average delay occurred as follows: referral to VBC meet 14 days (n=74), discussion to funding approval 9 days (n=69), medication receipt by homecare 10 days (n=64) and first order 11 days (n=46). We assume that in our clinic pre VC and, indeed, in the majority of UK Rheumatology Departments about 90% of patients recommended for a biologic by a specialist eventually ends up taking that medication and given that assumption potential costs savings with this model are estimated as equivalent to 35 patients (approx. £140K/yr. - drug costs savings calculated vs current cheapest option, SB4 (£4080/yr)). Conclusion Our study highlights that transforming biologic prescribing with a one-step virtual MDT clinic improves efficiency, significantly reduces patient access time and should ensure the most cost- effective treatment is agreed. Integration of the local research team in the VC allows eligible patients to be recruited for clinical trials where available offering further NHS cost savings. The VC creates a reliable, excellent training environment to maintain and enhance specialist knowledge and to deliver high standards of patient care. Disclosure of Interests None declared