February 2014 Vol 7, No 1, Special Issue ASH 2013 Payers' Perspectives in Oncology - Web Exclusive
Wayne Kuznar

“We found time-savings from the patient’s perspective in the range of 50% to 80%, which is pretty impressive, but we also have savings in the active healthcare professional time…in the range of 40% going up to 50%.”—Christof Wiesner, PhD, MPH

New Orleans, LA—The efficiency of rituximab (Rituxan) and the associated cost can be improved by switching from intravenous (IV) to subcutaneous (SC) administration. Such a switch led to a substantial reduction in patient chair time and in active healthcare professional time, said Christof Wiesner, PhD, MPH, of the Market Access Department, Genentech, San Francisco, CA, at the ASH 2013 meeting.

Rituximab is the standard treatment for indolent non-Hodgkin lymphoma and is currently administered by IV infusion. Results from studies of follicular lymphoma showed that a fixed-dose SC formulation of rituximab shortened administration time, without compromising the drug’s efficacy or safety.

Dr Wiesner and colleagues conducted a multinational, prospective, observational study to assess the possible resource benefits of switching from IV rituximab to SC administration. The data for rituximab SC injections were collected alongside a phase 3b trial, whereas the data for IV rituximab infusions were collected in a real-world setting in 23 international centers.

“We found time-savings from the patient’s perspective in the range of 50% to 80%, which is pretty impressive, but we also have savings in the active healthcare professional time…pharmacists and nurses, in the range of 40% going up to 50%,” said Dr Wiesner.

The difference in the mean active healthcare professional time saved by switching from IV rituximab to SC rituximab ranged from 7.3 minutes (Austria) to 30.9 minutes (United Kingdom). The proportionate reduction in mean healthcare professional time ranged from 28% (Spain) to 59% (Russia).

The mean time saved in the treatment room ranged from 28% to 59%. Over the course of the first year of treatment (8 induction and 3 maintenance sessions), the estimated reduction in total healthcare professional time associated with the switch from IV to SC rituximab ranged from 1.2 hours in Austria to 5.1 hours in the United Kingdom. The estimated chair time saved per patient for the first year of treatment ranged from a low of 31 minutes to a high of 60 minutes.

The estimated healthcare professional cost-savings per patient in the first year of treatment ranged from 25% in Spain to 52% in Russia. The healthcare professional opportunity cost-savings were driven mainly by a reduction in pharmacy staff time in Spain and in the United Kingdom, and by a reduction in physician and nurse time in other countries.

More Patients with Diffuse Large B-Cell Lymphoma Receive Rituximab in the Hospital
“Higher infusion-day costs contributed to higher unadjusted mean per patient per month costs among the hospital cohort.”—Carolina Reyes, PhD

A separate retrospective analysis of rituximab infusions presented at the meeting showed that more patients with diffuse large B-cell lymphoma (DLBCL) receive the infusions in the hospital setting, incurring greater costs than those receiving them in the office/clinic.

Rituximab in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) is the recommended first-line therapy for DLBCL.

Carolina Reyes, PhD, of Genentech, San Francisco, CA, examined differences in treatment patterns, healthcare resource use, and costs among patients with DLBCL receiving rituximab plus chemotherapy in the office setting versus the hospital outpatient setting.

Medical and pharmacy claims from a large, geographically diverse US commercial health plan were used to identify 491 adults with DLBCL with 2 or more claims for rituximab, 65% of whom received infusions in the office or clinic, and 35% of whom received them in the hospital.

Of the 491 patients, 140 were covered under Medicare Advantage, and 351 were commercially insured. The percentage of patients receiving infusions in the hospital increased from 32% in 2007 to 43% in 2011/2012.

The mean length of episode of care was not significantly different by the site of service, and the mean number of rituximab infusions was lower (4.92) in the hospital versus the office or clinic (6.52), as was the mean number of infusions per month (1.01 vs 1.17, respectively).

The total mean costs during the episode of care, as well as administration costs incurred on days of rituximab infusions, were significantly higher among the hospital cohort compared with the office/clinic cohort.

The unadjusted mean infusion-day costs were $12,481 in the hospital cohort versus $5834 in the office/clinic cohort.

“Higher infusion-day costs contributed to higher unadjusted mean per patient per month [PPPM] costs among the hospital cohort,” noted Dr Reyes. Total unadjusted PPPM costs in the hospital cohort were $22,325 compared with $15,541 for the office/clinic cohort.

“These results warrant further investigation to assess the impact of these differences on clinical outcomes by site of care,” according to Dr Reyes.

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Last modified: March 13, 2014
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