Subcutaneous vs intravenous rituximab in patients with non-Hodgkin lymphoma: a time and motion study in the United Kingdom

Abstract

Objective:

Rituximab is part of standard therapy for many non-Hodgkin lymphoma (NHL) patients, and is usually administered as an intravenous (IV) infusion. A formulation for subcutaneous (SC) injection will be available from June 2014. A time and motion study was conducted to investigate the staff time and costs associated with administration of SC and IV rituximab.

Research design and methods:

The time and motion study was conducted in three UK centers alongside a phase III trial of SC rituximab in patients with NHL (ClinicalTrials.gov identifier NCT01461928). Active healthcare professional (HCP) time spent on the preparation and administration of IV and SC rituximab was recorded and used to calculate the associated costs.

Results:

Total active HCP time associated with administration of IV rituximab was 223.3 min (95% CI = 218.0–228.7), vs 48.5 min (95% CI = 45.5–51.6) for SC rituximab, a saving of 174.8 min (95% CI = 172.5–177.1) per session. Patient time in the treatment room was 263.8 min (95% CI = 236.6–294.3) for IV rituximab and 70.0 min (95% CI = 57.1–87.2) for SC rituximab, per session. The SC formulation reduced total mean staff costs by £115.17 (95% CI = 98.95–136.93) per session. Differing monitoring scenarios during infusion consistently showed time and cost savings for SC rituximab.

Limitations:

Study limitations include the non-interventional design and lack of statistical power, and the investigational nature of SC rituximab. The data collected did not account for patient and center characteristics and variability on active HCP time.

Conclusions:

SC rituximab was associated with reduced active HCP time and costs vs IV rituximab, as well as reduced patient time in the treatment room. Switching from IV to SC rituximab could increase treatment room capacity and patient throughput, as well as improving the patient experience.

Keywords::

• Rituximab
• Cost
• Time and motion
• Subcutaneous
• Intravenous infusion

Transparency

Declaration of funding

This study was funded by Roche Products Ltd.

Declaration of financial/other relationships

K. Samanta is a Roche employee; G. Collins has been in receipt of honoraria and travel grants from Roche; S. Rule had been in receipt of honoraria and research funding from Roche.

Acknowledgments

The authors would like to thank the participating centres in Plymouth, London, and Oxford, particularly Dr. David Cunningham, lead investigator of the London center. Assistance with data analysis was provided by UBC, and was funded by Roche Products Ltd. Editorial assistance with the preparation of this manuscript was provided by Succinct Medical Communications, also funded by Roche Products Ltd. Full editorial control was retained by the authors.

Notes

*MabThera is a registered trade name of Roche Ltd, Welwyn Garden City, UK.