Download Micro-costing study of rituximab subcutaneous injection

20th Congress of the European Haematology Association, June 2015, Vienna, Austria
Micro-costing study of rituximab subcutaneous injection versus intravenous infusion
in Dutch setting
Mihajlović J1,2, Bax P1, van Breugel E1, Blommestein HM3, Hoogendoorn M4, Hospes W5,6, Postma MJ1,7
1Unit
of PharmacoEpidemiology & PharmacoEconomics, University of Groningen, Netherlands, 2Mihajlović Health Analytics, Novi Sad, Serbia, 3Erasmus University, Rotterdam, Netherlands 4Department of
Haematology, Medical Center Leeuwarden, Netherlands, 5Department of Pharmacy, Isala Clinics, Zwolle, Netherlands, 6Department of Pharmacy, Ommelander Zorggroep, Winschoten/Delfzijl, Netherlands,
7Institute of Science in Healthy Aging & health caRE (SHARE), University Medical Center Groningen, Netherlands
Material costs
Background
 Diffuse large B-cell lymphoma (DLBCL) is the most common type of NonHodgkin Lymphoma (NHL) comprising 30-58% of NHL cases.
 Intravenously
(IV)
administered
rituximab
combined
with
cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) is
the standard initial treatment of DLBCL.
 Rituximab for subcutaneous (SC) administration has recently been
approved for use in common forms of DLBCL.
 This form of rituximab is supplied in ready-to-use vials that do not require
individual dose adjustment.
 It is expected that SC-injection will shorten the treatment time per
administration of rituximab in comparison with currently available
intravenous (IV) infusion
 The goal of this study is to identify and compare all direct costs of IV and
SC rituximab administered to the DLBCL patients in the Dutch setting
Methods
 The study was conducted alongside the MabEase phase IIIB international
clinical trial of Hoffmann-La Roche from December 2012 until January
2014 in several hospitals in the Netherlands (an ongoing non-inferiority
study that compares SC and IV rituximab in DLBCL patients).
 We measured time and calculated respective costs for 20 administrations
of SC rituximab and 33 administrations of IV rituximab performed by
nurse in the chemotherapy unit.
 We also followed preparation of 7 IV infusions and 6 SC injections
perforemed by pharmacist’s assistant.
 Costs were divided into four classes: i) drug costs including spillage, ii)
labor costs, iii) daycare treatment costs and iv) material costs.
Drug costs including spillage
 The drug costs of IV and SC rituximab were retrieved from the official
pricelist as of September 2014 (500mg of IV rituximab was priced at
€1351.02 and 1400mg of SC rituximab at €1822.15)
 Rituximab IV was given in doses of 375 mg/m2, while rituximab SC was
given in a unique dose of 1400mg for all patients regardless of their body
surface area (BSA) according to the drugs official posology.
 Spillage of rituximab IV could not have been estimated from the original
sample (N=33), thus we collected real world data on rituximab IV cost
spillage (412 patients from Isala Clinics in Zwolle (ICZ) and 517 patients
from Medical Center Leeuwarden (MCL))
 Material costs related to the use of disposable materials for IV and SC
administration that was not included in the daycare costs treatment (syringes,
clamps, needles, etc.)
Results
 Drug cost per patient of SC rituximab was €85.34 lower than that of IV
rituximab, estimated from 33 IV and 20 SC administrations (p=0.0273, Table
1). Spillage of IV rituximab was estimated at €69.11 using secondary data from
ICZ (412 patients) and MCL (517 patients).
 Labor costs of a nurse were less for IV than for SC administration and the
difference was estimated at €1.43 per patient (p=0.05, Table 2). Labor cost of
two pharmacist’s assistants differed insignificantly for IV and SC rituximab
(p=0.41) when estimated on preparations of 7 IV and 6 SC.
 Daycare treatment costs (cost of CTU) correlated with significant difference in
time needed for IV and SC administration (mean times of 139.30 and 57.80
min. per administration, respectively) and were lowered by €102.39
(p<0.0001, Table 2) when SC rituximab was used.
 Material costs differed for IV (€5.40) and SC administration (€1.38), however,
this was based on one estimate of disposables’ costs taken per each type of
administration.
Table 2. Measurements of nurses’ and chemotherapy unit (CTU) time and costs
Table 1. Measurements of BSA, doses and drug costs
IV rituximab
Measurement
number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Mean
Lower limit of
95% CI
Upper limit of
95% CI
Standard
deviation
IV rituximab
SC rituximab
BSA (m2)
Dose (mg)
Cost (€)
1.6520
2.1829
1.8821
1.4277
1.8004
1.9637
1.8661
2.1438
1.7032
1.9994
1.6203
1.8980
2.0186
1.7252
1.8338
2.3364
1.5812
2.0609
1.7455
2.0850
1.8173
1.9303
1.6791
1.7829
1.9468
2.1121
2.0389
1.5274
1.8501
1.9812
1.9140
1.7647
2.2367
1.8821
619.49
818.59
705.77
535.37
675.14
736.40
699.79
803.92
638.71
749.79
607.61
711.75
756.97
646.94
687.68
876.17
592.95
772.83
654.57
781.87
681.49
723.85
629.67
668.58
730.05
792.05
764.60
572.78
693.77
742.96
717.77
661.75
838.76
705.77
1674.18
2212.57
1907.49
1446.72
1824.65
1990.33
1891.32
2172.91
1726.15
2026.53
1642.07
1923.66
2045.93
1748.41
1858.59
2368.26
1602.41
2088.83
1769.04
2113.28
1841.83
1956.39
1701.70
1806.92
1973.15
2140.80
2066.57
1547.86
1875.05
2008.06
1939.93
1788.45
2267.12
1907.49
1.8108
679.03
1.9533
0.2090
Measurement
number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
BSA (m2)
Dose (mg)
Cost (€)
1.6152
1.7455
1.7695
1.7177
1.8204
1.8473
1.6791
1.7501
1.7921
1.8821
1.8880
1.9740
1.9603
2.0518
2.0289
1.9312
1.9594
2.1735
2.0189
2.1109
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1400
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1822.15
1.8858
1400.00
1822.15
1835.19
1.8198
1400.00
1822.15
732.51
1979.79
1.9518
1400.00
1822.15
78.3649
211.9065
0.1505
0.0000
0.0000
SC rituximab
Measurement Total nurse Nurse costs Total CTU Daycare
number
time (min)
(€)
time (min) costs (€)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Mean
Lower limit of
95% CI
Upper limit of
95% CI
Standard
deviation
17.93
16.85
12.58
11.73
15.65
9.37
8.33
11.45
13.57
8.58
15.88
11.97
13.67
7.88
12.9
9.25
13.03
8.7
15.22
17.65
18.4
19.78
7.23
19.72
16.58
10.9
17.33
12.97
12.3
20.22
19.7
11.52
11.67
13.65
9.04
8.49
6.34
5.91
7.88
4.72
4.2
5.77
6.84
4.32
8
6.03
6.89
3.97
6.5
4.66
6.57
4.38
7.67
8.89
9.27
9.97
3.64
9.93
8.36
5.49
8.73
6.53
6.2
10.19
9.93
5.8
5.88
6.88
147
150
140
133
125
105
100
126
109
140
105
225
126
123
125
160
129
126
179
115
161
138
138
126
124
119
157
103
138
230
196
138
141
139.3
184.67
188.44
175.88
167.09
157.04
131.91
125.63
158.29
136.93
175.88
131.91
282.66
158.29
154.52
157.04
201.01
162.06
158.29
224.87
144.47
202.26
173.37
173.37
158.29
155.78
149.50
197.24
129.40
173.37
288.94
246.23
173.37
177.14
175.00
12.33
6.22
128.74
14.97
7.54
3.8622
1.9467
Measurement Total nurse Nurse costs Total CTU
number
time (min)
(€)
time (min)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Daycare
costs(€)
15.97
17.55
12.85
15.92
19.85
19.98
17.22
15.62
11.82
16.25
16.22
21.57
16.15
17.77
19.12
17.67
16.92
11.8
9.75
19.95
8.04
8.84
6.47
8.02
10
10.07
8.67
7.87
5.95
8.19
8.17
10.87
8.14
8.95
9.63
8.9
8.52
5.84
4.91
10.05
60
85
17
55
80
85
95
24
27
60
29
92
30
48
21
112
73
67
16
80
75.38
106.78
21.36
69.10
100.50
106.78
119.35
30.15
33.92
75.38
36.43
115.58
37.69
60.30
26.38
140.70
91.71
84.17
20.10
100.50
16.50
8.31
57.80
72.61
161.73
15.16
7.63
44.75
56.22
149.86
188.27
17.84
8.99
70.85
89.01
30.9521
38.8845
3.0532
1.5478
29.7757
37.4066
 Difference in total costs for administration of IV (€2166.77) and SC rituximab
(€1907.15) was estimated at €259.62 per patient (95% CI: €226.55-292.69,
Table 3).
Table 3. Total costs difference between IV and SC rituximab administration
Labor costs
 Labor costs related to the time needed for preparation of
infusion/injection done by two pharmacist’s assistants and administration
of the drug done by a nurse.
 Per hour wages of medical staff were taken from the official wage reports
(€21.43/h for a pharamacist assistant and €30.23/h for a nurse)
Daycare treatment costs
Cost item
Costs for IV
rituximab
administration
Costs of SC
rituximab
administration
Costs' difference
p-value
Drug costs
1907.49
1822.15
85.34
0.0273
Spillage cost
69.11
0.00
69.11
N/A
Material costs
5.40
1.38
4.02
N/A
Labor costs (nurse)
6.88
8.31
-1.43
0.0050
2.89
2.70
0.19
0.4119
Daycare costs
175.00
72.61
102.39
<0.0001
Total costs
Lower limit of 95% CI
2166.77
1907.15
259.62
2125.36
1897.98
226.55
Upper limit of 95% CI
2208.18
1916.33
292.69
Standard deviation
107.7268
18.7208
77.3160
Labour costs (preparation)
Conclusions
 Standard daycare treatment cost concerned costs of facilities and capital
investment and was cited from a recent Dutch report on costs of hospital
 Rituximab administered in the form of SC injection is less costly than its IV form
services amounting to €175. This was divided by the mean time [min.] of
 Costs difference is mainly based on savings related to the shorter time spent in
IV administration to obtain daycare treament cost per minute for a
CTU, reduced drug cost and lack of spillage when SC rituximab is used.
chemotherapy unit (CTU).
 Taking into account their equal effectiveness, favorable economic profile of SC
 Multiplying mean time [min.] of a SC administration by the average cost
rituximab can result in significant savings when transferred to the total DLBCL
of CTU minute we calculated daycare treatment cost for SC rituximab.
population in the Netherlands.
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