Societal cost of subcutaneous and intravenous trastuzumab for HER2-positive breast cancer – An observational study prospectively recording resource utilization in a Swedish healthcare setting

• Published in: Breast (Edinburgh) 2016-10, Vol.29, p.140-146
• Main Authors: Olofsson, Sara, Norrlid, Hanna, Karlsson, Eva, Wilking, Ulla, Ragnarson Tennvall, Gunnel
• Format: Article
• Language: English
• Subjects: Administration, Intravenous; Aged; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - economics; Breast Neoplasms - chemistry; Breast Neoplasms - drug therapy; Breast Neoplasms - economics; Female; Health Care Costs; Health Resources - economics; Health Resources - utilization; Hematology, Oncology and Palliative Medicine; HER2-positive breast cancer; Humans; Injections, Subcutaneous; Intravenous; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Prospective Studies; Resource use; Societal cost; Subcutaneous; Surveys and Questionnaires; Sweden; Trastuzumab; Trastuzumab - administration & dosage; Trastuzumab - economics
• ISSN: 0960-9776; 1532-3080; 1532-3080
• DOI: 10.1016/j.breast.2016.07.008

Abstract Introduction Trastuzumab is part of the standard treatment for HER2-positive breast cancer. The aim of this study was to estimate the societal value of trastuzumab administered through subcutaneous (SC) injection compared to intravenous (IV) infusion. Methods Female patients with HER2-positive breast cancer receiving SC or IV trastuzumab were consecutively enrolled from five Swedish oncology clinics from 2013 to 2015. Data on time and resource utilization was collected prospectively using patient and nurse questionnaires. Societal costs were calculated by multiplying the resource use by its corresponding unit price, including direct medical costs (pharmaceuticals, materials, nurse time, etc.), direct non-medical costs (transportation) and indirect costs (production loss, lost leisure time). Costs were reported separately for patients receiving trastuzumab for the first time and non-first time (“subsequent treatment”). Results In total, 101 IV and 94 SC patients were included in the study. The societal costs were lower with SC administration. For subsequent treatments the cost difference was €117 (IV €2099; SC €1983), partly explained by a higher time consumption both for nurses (14 min) and patients (23 min) with IV administration. Four IV and 16 SC patients received trastuzumab for the first time and were analysed separately, resulting in a difference in societal costs of €897 per treatment. A majority of patients preferred SC to IV administration. Conclusion SC administration resulted in both less direct medical costs and indirect costs, and was consequently less costly than IV administration from a societal perspective in a Swedish setting.