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M-26: Like We Have a Choice: A Qualitative Study of Patients’ Views on Epoietin Biosimilars for Anemia of Chronic Kidney Disease

Poster Presenter

      Nicole Tsao

      • Senior Manager, RWE strategy
      • Biogen
        United States


To determine chronic kidney disease patients’ and caretakers’ opinions on epoetin biosimilars, and identify the key attributes for a preference elicitation experiment.



A convenience sample of patients/caregivers from across Canada were invited to participate in 1.5hr semi-structured focus groups. Discussion focused on potential benefits, costs, safety, and policies of erythropoietin biosimilars. Focus groups were transcribed and analyzed using thematic analysis.


A total of eight chronic kidney disease patients/caregivers of patients from 5 Provinces participated in two focus groups during July 2016, 75% of participants were between ages 45 to 65. In general, participants had minimal awareness regarding biosimilars, but were somewhat familiar with concepts of reducing costs to the healthcare system through market competition. Thematic analysis of the transcripts resulted in 5 overlapping themes that were important to participants regarding the use of epoeitin biosimilars for anemia of chronic kidney disease: 1) How “similar” is biosimilar?; 2) Safety and monitoring; 3) “If it ain’t broke, don’t fix it”; 4) “What’s in it for me?”; and 5) Not having a choice/voice. Theme 1 encompassed participants’ concerns around the comparability between originator and biosimilar drugs in terms of their efficacy, safety, and characteristics of the medications. Participants wanted to see that the biosimilars have undergone testing in patients like themselves. One participant stated “my preference would be of course have a drug that’s been tested on kidney patients and not on, you know, anybody”. Theme 2 demonstrated that with respect to the side effect profile of biosimilars, understandably participants had low tolerance, especially if the side effects were different from or more frequent than the originator. However, they seemed accepting of temporary increases in blood monitoring if patients were switched to a biosimilar from an originator. There were many overlapping discussions that included themes 3, 4, and 5 as participants grappled with the idea of switching to a biosimilar with no foreseeable benefit if they were already stable on an existing epoetin. Many were afraid of not having a choice regarding their treatment, for example, if their insurer decided to priority list the biosimilar. One participant stated: “You have to realize autonomy is also extremely important. When you’re this critically ill these decisions are important.”


Based on thematic analysis of focus groups with a sample of participants with chronic kidney disease or their caregivers, we observed 5 major themes that represented areas of concern surrounding the use of epoetin biosimilars in anemia of chronic kidney disease. The themes reflected patients’ unsurprising desires to have comparable efficacy in their treatments without compromising safety. However, there was a general sentiment of unwillingness to switch from originators to biosimilars even if equal efficacy and safety were established. This appeared to be due to a lack of foreseeable benefit while risking stability of disease control, and a fear of losing autonomy in managing their health. The implications of our findings can be applied to not only biosimilars of epoetin but biosimilars in other therapeutic areas. In light of these findings, manufacturers, policy makers, and payers should consider educational programs for patients and their family members, and other patient support or incentive programs to help increase acceptance of biosimilars. Insurers may want to consider listing biosimilars and originators to provide patients with options. Future directions of our research include knowledge dissemination of findings from analogous focus groups of nephrologists, and policy makers, and constructing a discrete choice experiment for preference elicitation on biosimilar versus originator epoetins. Additional authors: Katherine Milbers, Hans Haag, Mark Harrison