A Look at the History of Biosimilar Adoption: Characteristics of Early and Late Adopters of Infliximab and Etanercept Biosimilars in Subregions of England, Scotland and Wales - A Mixed Methods Study

Background: Regions within England, Scotland and Wales show variation in rate of adoption of biosimilar infliximab and etanercept. Objectives: This study aims to examine how local decisions and practices in regions within England, Scotland and Wales might explain initial variation in market dynamics of biosimilar and originator infliximab and etanercept. Methods: Market data provided by the National Health Service (NHS) on biosimilar and originator infliximab and etanercept uptake were analysed for the 10 historical regions of England, 14 health boards in Scotland and 7 health boards in Wales (2015–2018). Findings were discussed in ten semi-structured interviews: on a national level with an industry representative (1), on a regional level with NHS employees in England (6), Scotland (1) and Wales (1), and on a local level with a representative of a clinical commissioning group in England (1). Results: Tenders for infliximab and etanercept in England, Scotland and Wales have consistently resulted in a biosimilar as the best value biological. Early and late biosimilar adopters are seen, with overall convergence towards high biosimilar market shares over time. Qualitative results suggest that biosimilar adoption was positively influenced by (a) a price difference between biosimilar and originator product making it worthwhile to switch patients; (b) a good relationship between commissioner and provider in England resulting in gain share agreements; (c) leadership on biosimilars in regional NHS offices in England or Scottish and Welsh health boards; (d) key opinion leaders or leading hospitals that start using biosimilars early and gain experience. Conclusions: This study has shown that the savings potential drives biosimilar use. Regions with a proactive attitude, good stakeholder relationships, and clinician engagement were identified as early adopters

Prescribing costs of hypoglycaemic agents and associations with metabolic control in Wales; a national analysis of primary care data

Aims: There has been a dramatic increase in hypoglycaemic agent expenditure. We assessed the variability in prescribing costs at the practice level and the relationship between expenditure and the proportion of patients achieving target glycaemic control. Methods: We utilized national prescribing data from 406 general practices in Wales. This was compared against glycaemic control (percentage of patients achieving a HbA1c level < 59 mmol/mol in the preceding 12 months). Analyses were adjusted for the number of patients with diabetes in each general practice and the Welsh Index of Multiple Deprivation. Results: There was considerable heterogeneity in hypoglycaemic agent spend per patient with diabetes, Median = £289 (IQR 247–343) range £31.1–£1713. Higher total expenditure was not associated with improved glycaemic control B(std) = −0.01 (95%CI –0.01, 0.002) p = 0.13. High‐spend practices spent more on SGLT2 inhibitors (16 vs. 9% p < 0.001) and GLP‐1 agonists (13 vs. 11% p < 0.001) and less on insulin (34 vs. 42% p < 0.001), biguanides (9 vs. 11% p = 0.001) and sulphonylureas (2 vs. 3% p < 0.001) than low spend practices. There were no differences in the pattern of drug prescribing between high spend practices with better glycaemic control (mean 68% of patients HbA1c <59 mmol/mol) and those with less good metabolic control (mean 58% of patients HbA1c <59 mmol/mol). Conclusions: Spend on hypoglycaemic agents is highly variable between practices and increased expenditure per patient is not associated with better glycaemic control. Whilst newer, more expensive agents have additional benefits, in individuals where these advantages are more marginal widespread use of these agents has important cost implications

Direct liquid crystal templating of mesoporous silica and platinum

Mesoporous silicas have been prepared with hexagonal (H1) pore morphologies from TMOS/Brij 56/water/HCl mixtures. A detailed study of the synthesis of mesoporous silica from such mixtures revealed that ordered structures are formed at both high (~50 wt%) and low (~0.1 wt%) surfactant concentrations. The liquid crystal phase behaviour of Brij 56 in water showed that at low surfactant concentrations an H1 structure formed from a phase separated solution. At the high concentrations of surfactant the H1 phase was homogeneous throughout the sample and the hexagonal pore structure was a replica of the initial H1 lyotropic phase with ~3.6 nm diameter pores and ~1.7 nm thick walls.Direct liquid crystal templating of platinum has been studied by the reduction of a platinum salt in the aqueous domains of an H1 phase to C16EO8. The most successful method of preparing H1 platinum employed reduction with iron metal at room temperature. BET surface area analysis showed the mesoporous platinum to have a surface area of ~60 m2g-1. This is almost twice the surface area for commercially available platinum black materials. The pore size of the H1 materials was found to be ~2.9 nm with ~3.9 nm thick walls. A phase diagram study of the C16EO8/H2PtCl6/H2O system made it possible to obtain cubic (V1) and lamellar (Lα) mesoporous platinum. Finally, mesoporous silicas have been successfully loaded with H2PtCl6 and reduced to platinum metal as a method of preparing a supported platinum catalyst. The platinum was found to aggregate into particles rather than line the pores of the mesoporous structure after reduction.</p

Do gambling activity patterns predict gambling problems? A latent class analysis of gambling forms among Australian youth

Although gambling frequency and easy access to gambling are predictive of gambling problems among young people, little is known about their patterns of gambling activities. The current study investigated the gambling patterns of a large sample of youth (N = 1061) using latent class analysis. Six activity classes of young gamblers were identified: rare, lottery/scratch card, broad ranging, pool, unrestricted access and heavy gamblers. The classes differed significantly on age, gender, number and type of gambling activities, gambling frequency, problem gambling and amount spent on gambling. In addition, the relationship between problem gambling and the amount spent differed across classes. The results indicate the value of assessing gambling patterns as well as gambling frequency in research examining problem gambling. Although older youth have more opportunity to legally engage in a wider range of gambling activities, young people's gambling activity patterns are more indicative of potential gambling problems than age

Why do heterosexual young adults who use reliable contraception also use condoms? Results from a diary-based prospective longitudinal study

Objectives: To identify characteristics of individuals and characteristics of sexual encounters that predict whether people using contraception will also use condoms (dual use), and to determine whether dual use is prompted by concerns about unplanned pregnancy and/or sexually transmitted infections (STIs). Design: A longitudinal prospective design was used to identify characteristics of individuals and characteristics of specific sexual encounters that predict condom use. Methods. A sample of 349 sexually active heterosexual young adults was recruited at universities and trade colleges in Melbourne, Australia. Participants completed a self-administered questionnaire, and a representative subsample (N=103) completed a structured condom use diary in which they reported on up to 10 instances of vaginal intercourse. Respondents reported use of condoms and other forms of contraception during 919 instances of vaginal intercourse. Results: In multivariate analyses, dual use of condoms in addition to other contraception was predicted by attitudes toward condoms, intentions to use condoms, partner type and discussion of condom use with sexual partners. Dual use was not related to greater concern about HIV/STIs or unplanned pregnancy. Conclusions: Encouraging heterosexual young adults to discuss condom use, and developing their skills for negotiation of condom use will increase rates of condom use, thereby reducing current high rates of unplanned pregnancy and STIs