In the treatment of non-Hodgkin lymphoma, faster infusion of rituximab (Rituxan) results in direct cost-savings for providers and for patients, reported John Hornberger, MD, of Cedar Associates, Menlo Park, CA, and a consultant to Genentech, at the 2012 ASH meeting.
This is especially important “in an era of landmark legislation designed to address concerns about rising costs of healthcare and place more emphasis on patient-centered research,” noted Dr Hornberger.
Although the direct medical cost-savings were relatively small, the savings in indirect costs were almost 40%, the study showed.
“The most influential parameters included cost to treat grade 3/4 adverse events, administration costs, and patient’s foregone income due to time for infusions. The savings per course may be greater if infusion centers are able to spread fixed costs, such as overhead, among a greater number of patients, resulting from the increased capacity to schedule more patients,” Dr Hornberger said.
The 90-Minute Infusion Data
According to its US prescribing information, rituximab is typically given over 4 to 6 hours for the first infusion and over 3 to 4 hours for subsequent infusions. Recently, the US Food and Drug Administration approved 90-minute infusions for patients with previously untreated diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) in cycles 2 to 8.
This new study assessed the cost from a US societal perspective of the faster infusion versus the conventional 4- to 6-hour infusion schedule in patients scheduled to receive rituximab 375 mg/m2 plus standard chemotherapy.
The model included the direct medical resources—chemotherapy administration, chemotherapy, pretreatment drugs (wholesale acquisition cost), and grades 3 and 4 adverse events—and the indirect visits for infusion costs to patients and caregivers.
The data came from the phase 3 RATE clinical trial that evaluated alternative dosing of rituximab in 451 untreated patients. The target population was projected to be 23,519 newly diagnosed patients with DLBCL and FL.
The estimated total direct medical cost for conventional infusion was $825,005,088; the cost of foregone in-come for patients and caregivers was $9,217,527.
The 90-minute infusion reduced the direct medical costs by $2,205,689 (0.3%) and foregone income by $3,598,649 (39%). This resulted in an average cost-savings of $42 per infusion and $247 per course of treatment.