Switching From IV to Subcutaneous Rituximab Saves Staff Time and Money

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The efficiency of rituximab administration and the cost associated with administration can be improved by switching from IV to subcutaneous (SC) administration. Such a switch led to a substantial reduction in patient chair time and in active healthcare professional (HCP) time, said Christof Wiesner, PhD, MPH.

Rituximab is the standard treatment for indolent non-Hodgkin lymphoma (iNHL), currently administered by IV infusion. Results from studies in follicular lymphoma showed that a fixed-dose SC formulation of rituximab shortened administration time without compromising efficacy or safety compared with an IV infusion.

Wiesner and colleagues conducted a multinational, prospective, observational time and motion study in which the possible resource benefits of switching from rituximab IV to SC administration were investigated. The data for rituximab SC injections were collected alongside the MABCUTE trial, which is exploring maintenance therapy with SC rituximab in patients with relapsed or refractory iNHL, while data for rituximab IV infusions were collected in a real-world setting in 23 centers in Italy, Russia, Slovenia, United Kingdom (UK), Spain, France, Austria, and Brazil.

Trained observers recorded both the time during which HCPs were actively completing prespecified tasks (using a stopwatch) and the patient chair time (based on length of time between patients entering and exiting chairs).

“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 Wiesner, from the Market Access Department at Genentech, South San Francisco, CA.

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

The mean time saved in the treatment room ranged from 28% (Spain) to 59% (Russia). Over the course of the first year of treatment (8 induction and 3 maintenance sessions), the estimated reduction in total HCP time associated with the switch ranged from 1.2 hours in Austria to 5.1 hours in the UK. The estimated chair time saved per patient for the first year of treatment was a low of 31 minutes in France to a high of 60 minutes in Italy.
“As a last step, we calculated cost savings, and they are in a similar range. A couple hundred of Euros saved for a typical course of therapy, based on assistant technical staff and nurse salary, among others,” he said.

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

The time savings could allow more time to be used for other patient care activities or increasing the number of patients who could be treated and thus increasing the overall efficiency of treatment centers, said Wiesner.

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