P394 Benefits of a VBIC to both patients and the local health economy

Introduction Virtual Biologics and Immunosuppressives Clinics (VBICs) assess inflammatory bowel disease (IBD) patients who are on biologics with a view to optimising treatments whilst also delivering cost savings through the withdrawal of high cost drugs. Darent Valley Hospital(DVH) is a district general hospital without an IBD Nurse. A VBIC was set up for the 1st time in July 2019 to assess the 112 patients on infliximab(IFX) to reassess patients’ treatment regularly but also with a view to demonstrating how an IBD nurse could be utilised to deliver cost savings. Methods Patients were assessed in VBIC by 2 IBD consultants, a pharmacy technician and an IBD administrator and categorised into 5 groups based on their recent investigations: to continue biologics, to reassess before offering withdrawal, to switch, to dose-escalate, or dose de-escalate. Letters were written to the patients’ consultant advising next management. Patients were analysed for: the group that they were assigned to, whether next management was performed and the number of patients offered withdrawal. Potential cost savings were estimated on the assumption that patients in the ‘reassess before offering withdrawal’ category, were likely to be in remission and would agree to withdraw. Costs were based on the price of IFX being £120/100 mg vial. Results 63 patients were analysed (62% male, 59% with Crohn’s, 41% on concomitant therapy, 13% had previous loss of response to adalimumab). The mean duration patients had been on IFX was 40 months (SD 32, range 1–140 months) and the mean time to their last disease assessment was 19 months (SD 15, range 1–69 months) of whom 33% were in remission at that time. Of the 40 (63%) patients in the ‘reassess before offering withdrawal’ category only 11 had all the investigations proposed by VBIC performed (see figure 1); only 5(8%) patients were withdrawn. If all patients in this category had been withdrawn, the savings would have been £162,480 in the 1st year and £324,960 in the 2nd year. Of the remaining 23 patients analysed, 3 were switched biologic, 5 were dose-escalated, 1 was de-escalated and 14 continued at their current dose. Overall, 19% of all the patients had subtherapeutic drug levels. Conclusions Before VBIC, a significant proportion of our patients had neither been reassessed regularly, nor offered withdrawn when in remission. However, although our VBIC was able to optimise therapy for some patients, it was unable to deliver the predicted cost savings. The reason for this was that it relied on the consultant in charge of the patient’s care performing the next management step; an issue that having an IBD nurse would resolve.