PSY33 - Evaluation of Subcutaneous Rituximab Administration Impacts on Canadian Systemic Therapy Suites

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Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy. Diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) comprise 55% of new NHL cases and are initially treated with rituximab-based chemoimmunotherapy. Relative to intravenous (IV) rituximab, a subcutaneous (SC) formulation approved in 2016 has comparable pharmacokinetics, efficacy and safety, with greatly reduced administration time, and is preferred by patients. The objective of this study was to estimate the impact of implementing rituximab SC with initial chemoimmunotherapy for FL and DLBCL over three years in the Canadian market on systemic therapy suite time and costs of drug acquisition and administration. An excel-based model was used with population size based on epidemiologic data and current rituximab use; duration of use considering initial therapy; time savings for rituximab SC administration from published studies; costs from standard Canadian sources; and uptake for implementing provinces assumed to be 65%, 75% and 80% over the 3 years. Key parameters and sensitivity analysis values were validated by clinical experts located in various jurisdictions of Canada. Costs are reported in 2017 Canadian dollars using a healthcare system perspective. Over 3 years after rituximab SC implementation, we estimated 5,762 Canadians using rituximab SC, with savings of 128,715 hours in systemic therapy suite time and approximately $40 million in drug and administration costs. Sensitivity analysis suggests the model is most sensitive to SC market uptake values, number of induction therapy cycles and eligible patients. SC administration of rituximab with initial chemoimmunotherapy can significantly reduce systemic therapy suite time and substantially save drug and administration costs.