Raine, T; Gkini, MA; Irving, PM; Kaul, A; Korendowych, E; Laws, P; Foulkes, AC
(2021)
Maintaining Clinical Freedom Whilst Achieving Value in Biologics Prescribing: An Integrated Cross-Specialty Consensus of UK Dermatologists, Rheumatologists and Gastroenterologists.
BioDrugs, 35 (2).
pp. 187-199.
ISSN 1179-190X
https://doi.org/10.1007/s40259-020-00464-5
SGUL Authors: Kaul, Arvind
|
PDF
Published Version
Available under License Creative Commons Attribution Non-commercial. Download (925kB) | Preview |
|
![]() |
Microsoft Word (.docx) (Supplementary material)
Published Version
Available under License Creative Commons Attribution Non-commercial. Download (51kB) |
Abstract
BACKGROUND: Biologics are now key drugs in the management of immune-mediated inflammatory diseases. However, the increasingly complex biologics environment and growing cost pressures in the UK have led to variability in drug commissioning and inequity of patient access across regions. OBJECTIVES: Our objectives were to provide consensus recommendations for enhancing the current situation in biologic prescribing in the UK by balancing clinical freedom with equitable distribution of biologics given the limited availability of resources. METHODS: A modified Delphi approach was used to reach integrated, cross-specialty consensus among dermatologists, rheumatologists and gastroenterologists practising within the English National Health Service (NHS). RESULTS: We describe the concepts of clinical freedom and clinical judgement and demonstrate how, together with patient choice, they can be exercised in the context of biologic prescribing in the NHS. We highlight that in England, local variations occur that are at odds with National Institute for Health and Care Excellence (NICE) guidance; these variably limit the degree to which clinicians can exercise clinical freedom and impact on equity of patient access to treatments. We define factors encompassing a drug's value and identify challenges to the measurement and interpretation of this concept, which can raise barriers to the freedom of clinical choice and appropriate prescribing decisions allowing practices of holistic and personalised medicine. Cross-specialty consensus recommendations on ensuring equitable access to biologics in the NHS while protecting appropriate and individualised drug selection for patients are provided. We have also provided strategies for improving physician-commissioner communication to harmonise equity of patient access to biologics across England and improve patient outcomes. Commentary from patient advisory groups indicates that they welcome our exploration that value does not equal cost and agree that there should be an emphasis on shared decision making, which requires the clinician to practice clinical freedom by aligning the patient's needs and preferences with available treatment choices. CONCLUSIONS: This consensus highlights the need to strike a balance between clinical freedom and short-term cost restrictions to support equitable resource distribution within the English NHS. Consideration of these recommendations may help to harmonise local, regional and national services and balance equity of patient access to biologic treatments with excellence in the NHS.
Item Type: | Article | ||||||||
---|---|---|---|---|---|---|---|---|---|
Additional Information: | © The Author(s) 2021 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/. | ||||||||
Keywords: | Biological Products, Consensus, Dermatologists, Freedom, Gastroenterologists, Humans, Rheumatologists, State Medicine, United Kingdom, Humans, Biological Products, Consensus, Freedom, State Medicine, United Kingdom, Rheumatologists, Gastroenterologists, Dermatologists, 1115 Pharmacology and Pharmaceutical Sciences, Immunology | ||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Institute of Medical & Biomedical Education (IMBE) Academic Structure > Institute of Medical & Biomedical Education (IMBE) > Centre for Clinical Education (INMECE ) |
||||||||
Journal or Publication Title: | BioDrugs | ||||||||
ISSN: | 1179-190X | ||||||||
Language: | eng | ||||||||
Dates: |
|
||||||||
Publisher License: | Creative Commons: Attribution-Noncommercial 4.0 | ||||||||
PubMed ID: | 33635522 | ||||||||
Go to PubMed abstract | |||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/114964 | ||||||||
Publisher's version: | https://doi.org/10.1007/s40259-020-00464-5 |
Statistics
Actions (login required)
![]() |
Edit Item |