P001 Use of high-cost drugs for inflammatory arthritis in English rheumatology departments: data from the GIRFT Rheumatology compartment in the Model Health System

Biologic drugs have been used in English rheumatology for 25 years and have transformed patients’ lives and the specialty itself. All rheumatology departments are bound by guidance from the National Institute for Health and Care Excellence and the British Society for Rheumatology; often also by local agreements. All English trusts record prescribing via the RxInfo Refine/Define platform and this information is now displayed on the Model Health System. In this abstract we describe variation in prescribing between English rheumatology departments.

All data included in this abstract, refer to the year to the end of quarter 3, 2023-2024 as the most recent data published at time of writing available on the Model Health System. Metrics are explained in detail on the Model Health System and were constructed by the rheumatology clinical leads with other members of the GIRFT programme. The drugs included in this analysis are: Abatacept, Adalimumab, Apremilast, Baricitinib, Bimekizumab, Certolizumab pegol, Etanercept, Golimumab, Guselkumab, Infliximab, Ixekizumab, Risankizumab, Rituximab, Sarilumab, Secukinumab, Tocilizumab, Tofactinib, Upadacitinib and Ustekinumab.

Although use of RxInfo is mandated nationally, a small number of units have nil or low returns, suggesting that a rheumatology cost centre is not used. Even after adjustment for patient volume, there is considerable variation between prescribing rates between departments, whether measured in financial spend or in defined daily dose. For defined daily dose (DDD), a proxy measure for number of patients treated, the median value per department is 3665 DDD per100 patients followed up, a rise from 3000 in 2019/20. The range is considerable, from 1947 to 6929 (IQR 2842-4245). Overall 71% of drugs prescribed are those where biosimilar versions are available (range 17-100%, IQR 65-77%), showing considerable variation which is difficult to account for on clinical grounds. Adalimumab is the most commonly prescribed drug overall, followed by etanercept, tocilizumab (including use for giant cell arteritis), and then similar rates for baricitinib, secukinumab, infliximab and certolizumab. Using adalimumab as an example, again considerable variation in prescribing rate is shown. Median rate is 1463 DDD per 100 patients, range 604-3012 and IQR 1069-1773.

Display of prescribing data on the Model Health System allows review of prescribing rates overall and of particular medications. We have attempted to standardise these rates by the size of a department’s patient cohort, to allow reasoned comparisons. As ever, beginning to review such data can raise more questions than answers. Considering that the same national guidance applies across all trusts, with minor local variations negotiated locally, there is striking variation in total prescribing and in selection of particular agents. Factors such as casemix, success with early aggressive treatment with conventional disease-modifying drugs particularly for rheumatoid arthritis and clinician choice will be interesting to explore further.

L. Kay: Other; Trustee of the National Axial Spondyloarthritis Society. L. Martin: None. P.C. Lanyon: None.