PSY76 - Cost-Minimization of Mabthera Intravenous Versus Subcutaneous Administration

Abstract

Objectives: To identify and compare all costs related to preparing and administrating MabThera for the intravenous and subcutaneous formulations in Dutch hematological patients. The a priori notion is that the costs of subcutaneous MabThera injections are lower compared to intravenous infusion due to potential lower time investments, shorter pharmacy preparation time, less patient chair time and less spillage. Methods: We use a prospective, observational, bottom up, micro-costing approach aiming at the inclusion of 50 patients with hematological disease. Primary cost outcomes comprise the labor costs for nurses and pharmacists/pharmacy technicians, materials, hourly daycare costs and drug spillage costs. Exact timings are measured using stopwatches, dosing and spillage is measured using registered MabThera volumes in the Hospital Pharmacies' registrations and materials are exactly numbered and labeled. List prices are used for materials and MabThera costs, hourly nurse and pharmacy time is costed according to salaries, and day-care is costed using the Dutch guideline for costing research in health care. Anticipating positive outcomes of the currently ongoing non-inferiority study, efficacy of MabThera along both administration routes was implicitly assumed similar; additionally parity pricing is assumed. Results: Interim results based on 24 patients included so far indicate that extra costs of intravenous infusion over subcutaneous injections are on average € 175 per administration. This difference is primarily constituted by € 100 lower daycare costs related to shorter chair time for subcutaneous as compared to intravenous administration. Conclusions: Our interim cost-minimization analysis suggests that subcutaneous injection of MabThera involves lower administration costs than intravenous infusion. With similar efficacy assumed, cost savings can be achieved at no expense of health, by including subcutaneous MabThera injections in the Dutch reimbursement system. Notably, over a full course of administrations (8 cycli) cost savings may easily surpass € 1000 per patient per year.