Abstract
BackgroundSubcutaneous (SC) versus intravenous (IV) administration is advantageous in terms of patient convenience and hospital efficiency. This study aimed to compare the effect of optimizing the processes involved in SC versus IV administration of rituximab and trastuzumab on hospital capacity and service quality.MethodsThis cross-sectional resource utilization study interviewed oncologists, hematologists, nurses, and pharmacists from 10 hospitals in Spain to estimate changes in processes associated with conversion from IV to SC rituximab and trastuzumab, based on clinical experience and healthcare use from administrative databases.ResultsEfficient use of SC formulations increased the monthly capacity for parenteral administration by 3.35% (potentially increasable by 5.75% with maximum possible conversion according to the product label). The weekly capacity for hospital pharmacy treatment preparation increased by 7.13% due to conversion to SC formulation and by 9.33% due to transferring SC preparation to the cancer treatment unit (potentially increasable by 12.16 and 14.10%, respectively). Monthly hospital time decreased by 33% with trastuzumab and 47% with rituximab. In a hypothetical hospital, in which all processes for efficient use of SC rituximab and/or trastuzumab were implemented and all eligible patients received SC formulations, the estimated monthly capacity for preparation and administration increased by 23.1% and estimated hospital times were reduced by 60–66%.ConclusionsConversion of trastuzumab and rituximab to SC administration could improve the efficiency of hospitals and optimize internal resource management processes, potentially increasing care capacity and improving the quality of care by reducing time spent by patients at hospitals.
Highlights
Subcutaneous (SC) versus intravenous (IV) administration is advantageous in terms of patient convenience and hospital efficiency
The aim of this fieldwork research was to: (1) identify all of the processes optimized by the use of the SC formulation in these Spanish hospitals; (2) determine performance indicators that would serve as measures to analyze changes in processes, times, volumes, and drug administration due to the SC conversion of both rituximab and trastuzumab; and (3) quantify the improvement in efficiency and healthcare quality as a result of the switch from IV to SC formulations
When used in combination with chemotherapy, between 0.0 and 91.7% of the trastuzumab doses were administered by SC infusion, and when used as part of maintenance therapy, between 39.8 and 100.0% of the trastuzumab doses were given by SC infusion
Summary
Subcutaneous (SC) versus intravenous (IV) administration is advantageous in terms of patient convenience and hospital efficiency. Rituximab (MabThera®; Roche) and trastuzumab (Herceptin®; Roche) were the first monoclonal antibodies (mAbs) approved for cancer treatment by the European Medicines Agency (EMA) in 1998 and 2000, respectively [1, 2]. The introduction of these drugs revolutionized the treatment of hematological and solid malignancies, with both becoming the standard of care for their respective indications. Both mAbs were first developed as intravenous (IV) formulations with weight-dependent dosing. The Spanish Agency for Medicines and Health Products approved SC trastuzumab in 2014 and SC rituximab in 2015
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