Dutch Experience Demonstrates Effective Benchmarking of Biosimilar Use in Health Systems

As medicines become more numerous and often more expensive, healthcare professionals seek new ways to understand which treatments are most likely to yield the best outcomes at sustainable costs.

The so-called learning healthcare system paradigm¹, an approach to using healthcare data to personalize care, reduce costs, and optimize resources, has been the subject of increased attention in recent years, and in 2012, a group of teaching hospitals in the Netherlands undertook construction of such a system as a means to benchmark the prescribing of biosimilar medicines and to assess how novel therapies impact survival in oncology patients in their system.

Researchers from the clinical pharmacy departments of these hospitals reported on their efforts in a paper in the European Journal of Hospital Pharmacy. The authors explain that the group of 7 hospitals, which together provide care to approximately 13% of the Dutch population, extracts data on a weekly basis from electronic health records that are used in routine clinical care.

By 2017, the database had accumulated records of 18,741,766 medication orders for 798,632 unique patients with prescriptions. These deidentified data are allowed in the Netherlands without informed consent from patients, and derive from both outpatient and inpatient sources.

These records allowed the hospitals to create benchmark reports that show the level of biosimilar prescribing in newly diagnosed patients with inflammatory bowel disease among the hospitals, and also allow users to see how many patients who are treated with anti—tumor necrosis factor therapies switch to other agents. “This provided insight that switching due to ineffectiveness is a rare phenomenon,” write the authors.

The database also allows users to generate interactive heatmaps that show how each individual hospital performs in terms of its prescribing; individual colors in the generated heatmaps demonstrate how much individual hospitals deviate from the overall population in terms of the drugs prescribed.

“Although recently established, we believe that having these data timely and in a uniform format largely broadens the opportunities for direct observations on trends in in-hospital medicine utilization and studying these trends in relation to relevant patient outcomes,” write the paper’s authors. They add that, for other groups of hospitals, it is feasible to construct databases that serve as tools to benchmark their use of key therapies and to monitor their impact on clinical outcomes.

References

1. Budrionis A, Bellika JG. The learning healthcare system: where are we now? A systematic review. J Biomed Inform. 2016;64:87-92. doi: 10.1016/j.jbi.2016.09.018.

2. van de Garde EM, Plouvier BC, Fleuren HWHA, et al. Pharmacotherapy within a learning healthcare system: rationale for the Dutch Santeon Farmadatabase. Eur J Hosp Pharm. 2019;26(1):46-50. doi: 10.1136/ejhpharm-2017-001329.