Institute for Medical Technology Assessment, Erasmus University Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands.
Institute for Medical Technology Assessment, Erasmus University Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands.
Breast. 2020 Aug;52:71-77. doi: 10.1016/j.breast.2020.05.001. Epub 2020 May 16.
To investigate resource use and time investments of healthcare professionals, patients and their family and to compare healthcare and societal costs of one single hospital-based and one single home-based subcutaneous administration of trastuzumab in The Netherlands.
We conducted a bottom-up micro-costing study. Patients diagnosed with HER2+ early or metastatic breast cancer were recruited in four Dutch hospitals. For healthcare costs, data were collected on drug use, consumables, use of healthcare facilities, time of healthcare professionals, and travelling distance of the nurse. For societal costs, data were collected on patient and family costs (including travelling expenses and time of informal caregivers) and productivity losses of paid and unpaid work.
Societal costs of one single administration of SC trastuzumab were €1753 within the home-based and €1724 within the hospital-based setting. Drug costs of trastuzumab were identical in both settings (€1651). Healthcare costs were higher for home-based administration (€91 versus €47) mainly because of more time of healthcare professionals (110 versus 38 minutes). Costs for patient and family were, however, lower for home-based administration due to travelling expenses (€7 versus €0) and time of informal caregivers (€14 versus €4). Costs for productivity losses were similar for both settings.
Home-based subcutaneous administration of trastuzumab is more time consuming for healthcare professionals and therefore more costly than hospital-based administration. The total budget impact can be large considering that a large number of patients receive a large number of cycles of oncology treatments. If home-based administration is the way forward, novel approaches are crucial for ensuring efficiency of home-based care.
调查医疗保健专业人员、患者及其家属的资源利用和时间投入，并比较荷兰单次医院和单次家庭皮下注射曲妥珠单抗的医疗保健和社会成本。
我们进行了一项自下而上的微观成本研究。在荷兰的四家医院招募了被诊断为 HER2+早期或转移性乳腺癌的患者。对于医疗保健成本，收集了药物使用、耗材、医疗设施使用、医疗保健专业人员时间以及护士的旅行距离的数据。对于社会成本，收集了患者和家庭成本（包括旅行费用和非正式照顾者的时间）以及带薪和无薪工作的生产力损失的数据。
家庭管理单次曲妥珠单抗皮下注射的社会成本为 1753 欧元，医院管理单次曲妥珠单抗皮下注射的社会成本为 1724 欧元。两种方案的曲妥珠单抗药物成本相同（1651 欧元）。家庭管理的医疗保健成本更高（91 欧元对 47 欧元），主要是因为医疗保健专业人员的时间更长（110 分钟对 38 分钟）。然而，由于旅行费用（7 欧元对 0 欧元）和非正式照顾者的时间（14 欧元对 4 欧元），家庭管理的患者和家庭成本较低。生产力损失的成本在两种方案中相似。
曲妥珠单抗的家庭皮下注射管理对医疗保健专业人员来说更耗时，因此比医院管理更昂贵。考虑到大量患者接受大量肿瘤治疗周期，总预算影响可能很大。如果家庭管理是未来的方向，那么确保家庭护理效率的新方法至关重要。
