P162 Evaluation of a remote tertiary hub-and-spoke model for the approval of high-cost drugs in medical dermatology

Abstract Use of high-cost drugs for management of immunobullous disorders and hidradenitis suppurativa (HS) in England requires specialized commissioning approval, meaning that patients may incur treatment delays and travel burden to be reviewed in a tertiary clinic. A hub-and-spoke model allows centres to refer cases for discussion via a secure online referral system, facilitating remote review and treatment approval at a tertiary specialized centre. We present the referrals received by one specialized centre and explore clinician satisfaction with the referral system and its outcomes during the 12-month period October 2023 to October 2024. In total, 31 referrals were received from 9 centres. Eighteen referrals were for HS: 11 for use of adalimumab and 7 for secukinumab. Ten referrals were for pemphigus vulgaris and use of rituximab. The remaining referrals were for other immunobullous disorders and rituximab use. Most cases (23 of 31) required one or two messages between the referrer and the multidisciplinary team (MDT), with further clinical information sought for 15 of 31 cases pending treatment approval (e.g. active nodule count for HS). Overall, 28 of 31 requests for treatment were approved. The median length of time from the date of referral to the date of tertiary approval was 5.5 days, matching that at the last review in 2017 despite an increased number of referrals. A survey was sent to 103 dermatology doctors for whom this specialized centre was their referral hub, with a response rate of 17.5%. The majority (89%, 16 of 18) found the remote referral form a useful tool to access treatment decisions. The vast majority were satisfied with the speed of reply (94%, 17 of 18). Most respondents felt confident to make their own treatment decisions (61% yes, 22% maybe, 17% no). Free-text responses elaborated that the need for tertiary approval for the management of HS may generate extra administrative burden. The tertiary specialized MDT service offers a prompt service for remote evaluation and approval of high-cost drugs without the need for patients to wait to be seen or travel long distances for a face-to-face clinic, which occurs at other UK centres. Referrers to the service are satisfied with its speed and effectiveness, although some question the need for tertiary approval for HS treatments, given familiarity with biologics. All biologic therapies currently licensed for the management of HS are repurposed treatments developed for the management of psoriasis and other autoimmune conditions, for which tertiary approval is not required. With HS affecting > 200 000 people in the UK, and more therapies being approved for use, it is conceivable that local decision making may become more appropriate, and these results suggest clinicians feel confident making such decisions. Tertiary discussion for rituximab use seemed to be deemed appropriate by users.