Diaz-Rangel Marca, Sanchez-Rubio Francisca, Drozdz-Vergara Andrea, Collado-Sanz Juan Manuel, Ruiz-Sanchez Sonia, Valladolid-Walsh Ana, Cercos-Lleti Ana Cristina
Pharmacy, Hospital General de Albacete, Albacete, Spain
Pharmacy, Hospital General de Villarrobledo, Albacete, Spain.
Eur J Hosp Pharm. 2025 Jun 24;32(4):338-341. doi: 10.1136/ejhpharm-2024-004324.
To analyse the economic impact of the use of immune checkpoint inhibitors in fixed-dose regimens and to determine the potential economic savings of using weight-adjusted dosing, as well as to describe the current situation in Spanish hospitals.
Observational, descriptive, retrospective and multicentre study that included all patients treated with pembrolizumab, nivolumab, avelumab, durvalumab and cemiplimab in fixed-dose regimens from 2020 to 2022 in four hospitals in a Spanish province (Albacete). Clinical variables: drug, therapeutic indication, body weight, percentage of overdose and number of cycles received. Economic variables studied included: cost per cycle (fixed-dose and weight-adjusted dosing), total cost and opportunity cost. The dosage regimen chosen for immune checkpoint inhibitors in Spain was carried out by means of an anonymous survey. The survey was sent out using a distribution list of the Oncology Pharmacy Working Group (GEDEFO) of the Spanish Society of Hospital Pharmacy (SEFH).
The study included 297 patients (155 pembrolizumab, 115 nivolumab, 12 avelumab, 11 durvalumab and 4 cemiplimab). The opportunity cost: pembrolizumab €615,316, nivolumab €486,327, avelumab €19,974, durvalumab €28,367 and cemiplimab €4,008. A total of 53 responses to the survey were received. In 54.7% of cases the weight-adjusted dosing regimen had been partially implemented in the prescription of some drugs and/or indications. In those hospitals that used weight-adjusted dosing, the decision was mainly made by the Pharmacy Service in consensus with Oncology (70.5%).
Our study showed a percentage of overdose of all drugs when using a fixed-dose regimen. This translates into a considerable increase in the budgetary impact versus the weight-adjusted dosing. The survey shows the scenario of our healthcare practice at the national level, confirming the variability in dosage regimens used in Spanish hospitals and the possible budgetary impact that therapeutic optimisation would entail.
分析使用固定剂量方案的免疫检查点抑制剂的经济影响，确定采用体重调整剂量可能节省的费用，并描述西班牙医院的现状。
观察性、描述性、回顾性多中心研究，纳入2020年至2022年期间西班牙某省（阿尔瓦塞特）四家医院所有接受帕博利珠单抗、纳武利尤单抗、阿维鲁单抗、度伐利尤单抗和西米普利单抗固定剂量方案治疗的患者。临床变量：药物、治疗适应证、体重、用药过量百分比和接受的周期数。研究的经济变量包括：每个周期的成本（固定剂量和体重调整剂量）、总成本和机会成本。西班牙免疫检查点抑制剂的给药方案是通过一项匿名调查确定的。该调查通过西班牙医院药剂师协会（SEFH）肿瘤药学工作组（GEDEFO）的分发名单发出。
该研究纳入297例患者（155例帕博利珠单抗、115例纳武利尤单抗、12例阿维鲁单抗、11例度伐利尤单抗和4例西米普利单抗）。机会成本：帕博利珠单抗615,316欧元、纳武利尤单抗486,327欧元、阿维鲁单抗19,974欧元、度伐利尤单抗28,367欧元和西米普利单抗4,008欧元。共收到53份调查问卷回复。在54.7%的病例中，体重调整剂量方案已在某些药物和/或适应证的处方中部分实施。在采用体重调整剂量的医院中，这一决定主要由药学服务部门与肿瘤科协商后做出（70.5%）。
我们的研究表明，使用固定剂量方案时所有药物均存在用药过量的情况。这意味着与体重调整剂量相比，预算影响大幅增加。该调查显示了我国医疗实践的情况，证实了西班牙医院使用的给药方案存在差异以及治疗优化可能带来的预算影响。
