Economic Impact of Using Subcutaneous Trastuzumab

Abstract

A641and capecitabine monotherapy in terms of incidence of diarrhea, vomiting, stomatitis/mucositis. The hand-foot syndrome occurrred in less than 5% in case of tegafur. Tegafur (in monotherapy or in combination with calcium folinate) is less costly than capecitabine. The difference in costs in favor of tegafur monotherapy amounted to € 1,956.97 per 1 patient per 6 months or € 3,778.53 per year; of tegafur + calcium folinate -€ 2,168.12 and € 4,220.06 per 1 patient per 6 and 12 months, respectively. ConClusions: Tegafur is a cost-saving option compared with capecitabine with similar efficacy and safety.objeCtives: There is new RCT phase 3 clinical evidence that bendamustinrituximab (B-R) is more effective in terms of progression free survival compared to the standard of care CHOP-rituximab (CHOP-R) in indolent non-Hodgkin lymphoma (iNHL). Based on this RCT, we performed a cost-utility analysis of B-R compared to CHOP-R in the treatment of follicular iNHL (stage III and IV) in the Czech Republic. Methods: We developed a life-time Markov cohort model with 28-day cycle length and 5 health states, i.e. on treatment, rituximab maintenance (R-M), stable disease, progression and death. Additionally, we modeled adverse effects of treatment and four sub-states during progression (observation, imunochemotherapy, R-M, post R-M). Transition probabilities and utilities were derived from published literature. Resource use (costs) was calculated from health care payer's perspective in cooperation with major Czech hemato-oncologic experts. Costs and outcomes were discounted by 3.5%. Probabilistic sensitivity analysis (PSA) with 1000 iterations using a willingness to pay (WTP) threshold equal to 3 times GDP per capita (40 100 EUR) in the Czech Republic was performed. Results: Over a life-time horizon, B-R compared to CHOP-R brings additional 1.21 QALY (7.47 vs. 6.26) and 1.31 LYG (9.74 vs. 8.43). The incremental total costs were 1,368 EUR (total life time costs for B-R and CHOP-R were 43,080 EUR and 41,712 EUR, respectively). ICERs thus equal to 1,133 EUR/QALY and 1,044 EUR/LYG. The results of the PSA show that B-R is costeffective in 100% iterations under the WTP threshold; and simultaneously in 99.3% iterations is cost-effective while using threshold equal to 7,300 EUR. ConClusions: B-R proved that it is a highly cost-effective therapy in patients with follicular iNHL. The higher costs of initial bendamustin treatment are in the long-term horizon offset by substantial savings of progression costs. There is 100% probability of B-R being cost-effective at the selected WTP threshold.

Efficacy and safety of subcutaneous trastuzumab and intravenous trastuzumab as part of adjuvant therapy for HER2-positive early breast cancer: Final analysis of the randomised, two-cohort PrefHer study

“…[5] A time-and-motion study within the PrefHer study demonstrated a mean time saving of 55-57 min of patient chair time and 13-17 min of active healthcare professional time per session with H SC compared with H IV, [6] and several countries have reported estimated increased hospital capacity and/or costsavings with H SC. [7][8][9][10][11][12][13][14][15][16][17] These data support a transition to SC delivery.…”

Cost-minimisation analysis of intravenous versus subcutaneous trastuzumab regimen for breast cancer management in Hong Kong

“…Data from other countries have demonstrated that for SC formulation of trastuzumab, less time is required for drug preparation and administration; moreover, fewer consumables are used. [10][11][12][13] A costminimisation analysis (CMA) study in Greece demonstrated that the total cost of therapy per patient was 21 870 euros (€) when using the SC formulation of trastuzumab, whereas it was €23 118 when using the IV formation of trastuzumab. The investigators concluded that use of the SC formulation of trastuzumab would provide cost savings for the Greek healthcare system.…”

“…10 A study in Spain revealed similar findings: the use of the SC formulation of trastuzumab led to a 19.4 to 28.8% cost savings in the hospital. 11 Additionally, a time-and-motion study in New Zealand compared medical resource utilisation between the IV and SC formulations of trastuzumab in patients with HER2-positive breast cancer. The potential cost saving was NZ$96.94 per patient per cycle.…”