Résumé
BackgroundMantle cell lymphoma is a cancer of the lymphocytes. Maintenance therapy can be performed with rituximab, administered intravenously or subcutaneously. Both formulations have different administration-associated costs and drug costs. The IV cost is influenced by dose, influenced by the body surface of the patient, whereas SC rituximab is at a fixed-dose.
Aim
The primary objective was to compare the global cost of IV (depending on the body surface area) versus SC rituximab to identify the most favorable formulation in a cost-minimization way, in routine medical practice. Discounts that could be proposed were considered.
A second objective was to focus on the time spent by patients in the hospital for each formulation.
Methods
A retrospective observational study comparing IV and SC rituximab was performed on 13 mantle cell lymphoma patients treated between 2015 and 2020 (representing 48 IV and 50 SC administrations). Several times and costs associated with rituximab administration were collected. An economic model was used.
Analysis
Administration times were 90 min and 5 min (+15 min observation time) for IV and SC rituximab. Nurses’ involvement was longer with SC rituximab (16,50 min vs 13,65 min). Drug preparation times by pharmacist were 294 seconds and 0 for IV and SC rituximab. Materials costs were 16,86 € and 5,01€ for IV and SC rituximab.
Rituximab cost for 1 cycle of maintenance therapy varied from 1 191,48€ to 1 787,22€ for IV rituximab. The fixed cost of SC rituximab was 1 398,67€. Additional non-drug costs with IV rituximab (1 injection) were 13,40 € (representing around 1% of the drug cost).
With a 10% IV discount, SC rituximab was cost saving for patients > 1.86 m2. From 20% IV discount, IV rituximab was cost saving for patients ≤ 2,13 m2.
If there were 15% SC discount and up to 20% IV discount, SC rituximab was cost saving for patients >1.86 m2. From 15% and 30% SC and IV discounts, IV rituximab was cost saving for patients ≤2.13m2.
Mean time spent in the hospital were 3h15 (3h15±0h38) and 2h12 (2h12±1h13) for IV and SC administrations.
Conclusion
IV rituximab was found cost saving in routine medical practice in most situations. SC formulation was cost saving in only three situations: 1) with no discounts, 2) with only 10% IV discount and 3) when there was 15% SC discount and 20% or less discount on the IV form.
Patient time in the hospital was approximately 1 hour longer with IV rituximab.
| la date de réponse | 21 janv. 2021 |
|---|---|
| langue originale | Anglais |
| L'institution diplômante |
|
| Superviseur | Marc Andre (Promoteur) |