Safety and cost benefit of an accelerated infliximab infusion protocol in the treatment of ambulatory patients with inflammatory bowel diseases

Abstract

Background: Infliximab is recommended to be infused over 2 h, but accelerated infusion rates of 30 min may improve efficiency, patient satisfaction and reduce nursing time and cost. The safety of this approach is not established. This study aims to assess the safety of accelerated infliximab infusion and determine the direct cost savings.

Methods: The primary endpoint of the study was adverse events and the secondary endpoints were cost, time saving per infusion and patient satisfaction associated with an accelerated infusion protocol.

Results: One hundred and thirty-six and 342 infusions were administered to 23 and 39 patients in the standard and accelerated protocols, respectively (mean infusion times 150 and 73.4 min, respectively, p < 0.0001). The adverse reaction rate of the standard protocol was 2.2% (95% confidence interval: 0.46 – 6.57) and accelerated protocol was 3.2% (95% CI: 1.74 – 5.73; p = 0.77). The odds ratio of adverse reaction for the 30-min infusion was 0.40 (95% CI: 0.09 – 1.82). The relative direct cost of nursing was decreased by 51.1% per infusion. Patient satisfaction score of the accelerated protocol was 9.2/10 (95% CI: 8.55 – 9.76) compared to 8.5/10 (95% CI: 7.83 – 9.17) in the initiation phase (p = 0.018).

Conclusions: Accelerated 30-min infliximab infusions significantly reduced nursing time, cost and increased patient satisfaction without increasing infusion reactions. Increased patient freedom and improved efficiency in healthcare delivery can be expected.

Keywords::

• adverse
• cost
• Crohn's
• inflammatory bowel disease
• infliximab
• safety

Acknowledgments

The study acknowledges the nursing team of the Gastroenterology and Liver Services, Concord Hospital, Sydney, and their high professional standards in the management of endoscopy and ambulatory IBD patients. R Burke oversaw the development of this audit.