The challenge of sustainability in healthcare systems: economic and organizational impact of subcutaneous formulations for rituximab and trastuzumab in onco-hematology

ABSTRACT

Background: This study estimated the economic and organisational impact of using subcutaneous injection (SC) formulations of two monoclonal antibodies (rituximab and trastuzumab) in patients with non-Hodgkin's lymphoma (NHL) and HER2 + breast cancer (BC).

Methods: The database of the Unit of Oncology and Haematology of the IRST of Meldola was used. The analysis was structured as follows: i) measurement of the volume of Day-Hospital activity; ii) identification of activities and time to complete the administration; iii) estimate the mean cost of an SC or IV (intravenous infusion); iv) estimate the impact of SC formulations on the volumes of activities provided; v) estimate the social impact of SC or IV formulations.

Results: The use of an SC formulation was associated a significant reduction in the time that the patient takes to complete the administration (trastuzumab -1 hr 18 min; rituximab -2 hr 24 min) and in consumption of healthcare resources and related costs for trastuzumab (IV: € 1781; SC: € 1701) and rituximab (IV: € 2116; SC: € 1941).

Conclusion: The adoption of the SC formulation for rituximab and trastuzumab can generate a greater value for both the national healthcare system and the patient compared to an IV formulation.

KEYWORDS:

• Rituximab
• trastuzumab
• subcutaneous formulations
• onco-hematology
• non-Hodgkin’s lymphoma
• HER2 breast cancer

Article highlights

• We evaluated the economic and organizational impact of using SC formulations of rituximab and trastuzumab in patients with NHL or HER2 breast cancer.

• The study used administrative data from the Day Hospital (2016).

• The use of an SC formulation was associated a significant reduction in the time that the patient takes to complete the administration (trastuzumab −1 hr 18 min; rituximab −2 hr 24 min)

• The use of an SC formulation was associated a significant reduction in consumption of healthcare resources and related costs for trastuzumab (IV: € 1781; SC: € 1701) and rituximab (IV: € 2116; SC: € 1941).

• The economic evaluations demonstrated that, compared to an IV formulation, the SC formulation for rituximab and trastuzumab can generate a greater ‘value’ for the Italian NHS and patients.

Author contribution statement

I Massa and N Gentili wrote the first draft. All authors interpreted the data and commented on the first draft. All authors revised the first draft. All authors agreed with the final version.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Ethical approval

The study was approved by the Independent Ethical Committee of the IRST of Meldola.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This study was supported by a grant from Roche, Italy.