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Review
. 2022 Sep 29;22(1):1211.
doi: 10.1186/s12913-022-08591-1.

Determinants of prescribing decisions for off-patent biological medicines in Belgium: a qualitative study

Yannick Vandenplas  1 , Steven Simoens  2 , Philippe Van Wilder  3 , Arnold G Vulto  2   4 , Florian Turk  5 , Isabelle Huys  2
Affiliations
Review

Determinants of prescribing decisions for off-patent biological medicines in Belgium: a qualitative study

Yannick Vandenplas et al. BMC Health Serv Res. .

Abstract

Background: A competitive market for off-patent biologicals leads to more affordable and high-quality healthcare. In recent years, Belgium has been characterized by its low use of biosimilars and by its shifts from off-patent biologicals toward new alternative therapies. Yet, the prescribing decisions involved in these observations are poorly understood. This study aims to better understand prescribing choices among Belgian physicians in the ambulatory care setting.

Methods: This study consisted of two phases. First, a scoping literature review to identify determinants of prescribing choices was conducted. Scientific databases (Embase and PubMed) were searched until 4 November 2021. Second, the nominal group technique (NGT) was employed during focus group discussions with Belgian physicians to consider and validate these determinants for off-patent biologicals in the Belgian context. The qualitative data resulting from the literature review and focus group discussions were analyzed using the thematic framework method.

Results: Fifty-three scientific articles that discussed elements that determine prescribing choices were identified. Out of these, 17 determinants of prescribing choices were found. These were divided into five categories: (1) product-related, (2) physicians' personal, (3) healthcare system-related, (4) patient-related, and (5) determinants related to the pharmaceutical company or brand. Nineteen Belgian physicians from different therapeutic areas that regularly prescribe biologicals then participated in focus group discussions. Using the NGT, the group discussions revealed that prescribing choices for off-patent biologicals are determined by a complex set of elements. Clinical data, geographical region, working environment, pharmaceutical marketing, patient profile, clinical guidelines, and preference of key opinion leaders (KOL) were considered most influential. Physicians indicated that the importance of these determinants differs depending on product classes or therapeutic domain.

Conclusions: Multiple elements determine the choice of an off-patent biological or biosimilar product. The importance of each of these determinants varies depending on the context in which the prescribing choice is made. To increase the prescription of best-value biologicals in the Belgian ambulatory care, a set of synergistic measures is required including information for healthcare providers (HCP) and patients, prescribing feedback, prescribing targets, tangible incentives, KOL involvement, guidelines regarding pharmaceutical promotion, and regular revision of reimbursement modalities.

Keywords: Behavior; Belgium; Biological medicine; Biosimilar; Policy; Prescription.

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Conflict of interest statement

This research project is funded by the Belgian National Institute for Health and Disability Insurance (NIHDI). NIHDI was not involved in the design of the study and collection, analysis, interpretation of data, nor in writing the manuscript.

SS, IH and AGV founded the KU Leuven Fund for Market Analysis of Biologics and Biosimilars following Loss of Exclusivity (MABEL). SS was involved in a stakeholder roundtable on biologics and biosimilars sponsored by Amgen, Pfizer, and MSD; he has participated in advisory board meetings for Pfizer, Sandoz, and Amgen; he has contributed to studies on biologics and biosimilars for Hospira (together with AGV and IH), Celltrion, Mundipharma, and Pfizer; and he has had speaking engagements for Amgen, Celltrion, and Sandoz. AGV is involved in consulting, advisory work, and speaking engagements for several companies, including AbbVie, Accord, Amgen, Biogen, EGA, Effik Benelux, Pfizer/Hospira, Mundipharma, Roche, and Sandoz. PVW acted as a healthcare consultant to public and private organizations, including pharmaceutical companies and their professional associations. FT acts as an advisor to, and is a consultant for, several pharmaceutical organizations and has represented pharmaceutical organizations in professional associations.

All other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
Overview of the methodological approach of this study
See this image and copyright information in PMC

References

    1. IQVIA . The global use of medicines 2022: outlook to 2026. 2021.
    1. OECD . Health spending (indicator) 2022.
    1. OECD . Pharmaceutical spending (indicator) 2022.
    1. National Institute for Health and Disability Insurance (NIHDI) Budget 2021 – Begrotingsvoorstel van het Verzekeringscomité. 2020.
    1. IQVIA . The Impact of Biosimilar Competition in Europe. 2020.

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