Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Breast Cancer Flow, Patient Area of Breast Cancer Sarcoma and Endocrine Tumors, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
PLoS One. 2019 Feb 4;14(2):e0211783. doi: 10.1371/journal.pone.0211783. eCollection 2019.
Adjuvant trastuzumab is a standard of care in the treatment of Human Epidermal growth factor Receptor 2 (HER2) positive early breast cancer (eBC). Initially trastuzumab could only be administered intravenously (IV), however since 2013, a subcutaneous (SC) formulation with comparable efficacy and safety profile is available and preferred by patients. Trastuzumab SC does not require pharmacy preparation and has shorter administration time. The objective of this study was to estimate the economic efficiency of the SC formulation of trastuzumab by assessing the economic benefits of actual SC-driven process changes at one single Swedish healthcare institution.
This study analyzes changes in trastuzumab administration practice after the SC formulation was introduced at the Karolinska University Hospital. Process changes were identified and introduced in order to capitalize on the inherent work efficiency benefits of the SC formulation. Actual hospital data for 2015 were used to quantitatively estimate the annual economic impact of the changes. It encompassed administrative (i.e. non-medical) data of 178 newly diagnosed HER2-positive eBC patients and a total of 2,769 SC administrations. Realized economic benefits were expressed in hours saved by nurses, direct monetary cost savings and potential infusion fee revenue that could be earned through infrastructural revenue gains.
In 2015, the replacement of IV infusion to SC administration generated total time savings of more than 1,100 hours, and led to direct monetary cost savings of 603,000 EUR. It unlocked a capacity gain of 1-2 additional administrations daily within the existing facility infrastructure. Given the current remuneration structure per administration, this revenue gain translated into an incremental revenue potential of up to 3 million EUR.
Data from this study showed that the shift from trastuzumab IV to SC formulation resulted in significant economic effects in terms of departmental resources related to time, direct monetary cost savings, and infrastructural revenue gains.
曲妥珠单抗辅助治疗是治疗人表皮生长因子受体 2（HER2）阳性早期乳腺癌（eBC）的标准治疗方法。最初，曲妥珠单抗只能静脉注射（IV）给药，但是自 2013 年以来，已经有一种具有相似疗效和安全性的皮下（SC）制剂可供使用，并且受到患者的青睐。曲妥珠单抗 SC 不需要药剂师进行配制，并且给药时间更短。本研究的目的是通过评估一家瑞典医疗机构中实际的 SC 驱动的流程改变所带来的经济效益，来估算曲妥珠单抗 SC 制剂的经济性。
本研究分析了在 Karolinska 大学医院引入曲妥珠单抗 SC 制剂后，曲妥珠单抗给药实践的变化。为了充分利用 SC 制剂固有的工作效率优势，确定并引入了流程改变。使用 2015 年的实际医院数据来定量估计这些改变的年度经济影响。它包括 178 例新诊断的 HER2 阳性 eBC 患者的行政（即非医疗）数据和总共 2769 次 SC 给药。通过节省护士的时间、直接节省货币成本以及通过基础设施收入获得潜在的输注费收入来表示实现的经济效益。
2015 年，将 IV 输注转换为 SC 给药共节省了 1100 多个小时的时间，直接节省了 603000 欧元的成本。它在现有设施基础架构中释放了 1-2 次额外给药的能力。考虑到当前的每次给药报酬结构，这一收入增长转化为高达 300 万欧元的增量收入潜力。
本研究的数据表明，从曲妥珠单抗 IV 转换为 SC 制剂在部门资源方面带来了显著的经济效果，包括与时间相关的资源、直接节省货币成本以及基础设施收入增加。
