Spanish Study: Subcutaneous Trastuzumab Administration Saves Time, Money

In patients with early or metastatic HER2-positive breast cancer or HER2-positive metastatic gastric cancer, trastuzumab is administered every 3 weeks for 1 year (or until disease progression) by intravenous infusion. The duration of administration is typically 90 minutes in the first infusion, and 30 minutes for each subsequent administration. A subcutaneous (SC) administration of reference trastuzumab, Herceptin, is approved for use in the European Union (and is undergoing a phase 3 trial in the United States). A newly published study, appearing in Clinical and Translational Oncology, finds that SC administration of trastuzumab produces substantial time savings for healthcare providers and patients, as well as reduced costs.

The prospective, observational time-and-motion study conducted in 3 medical centers in Spain recorded the active time that providers expended on trastuzumab SC- and intravenous- (IV) related tasks (including collection, reconstitution, and signing off on the prepared trastuzumab, as well as installing the venous catheter, administering pre-medications, monitoring the patient, and other tasks), and calculated provider time as the mean sum of tasks over 154 administrations. Researchers also calculated mean patient infusion chair time and treatment room time.

Staff costs were calculated using Spanish salaries, and direct costs (including the cost of consumables and of trastuzumab) and indirect costs (including loss of productivity) were also calculated.

In total, 159 patients received trastuzumab in IV administration, and 148 patients received SC trastuzumab. SC administration was associated with reduced active provider time in all 3 centers, with an average time of 13.2 minutes (95% CI; range, 8.9-17.5) versus 27.2 minutes for IV administration (95% CI; range, 2.18-32.6). The greatest reduction was in nursing time, but there were also significant reductions in pharmacist and nursing assistant time.

SC administration also reduced the time spent in the treatment room, as it eliminated catheter, premedication, drug transport, and monitoring tasks. In the preparation area, SC trastuzumab resulted in reduced material preparation time (3.9 minutes versus 6.0 minutes) and drug reconstitution time (0 minutes versus 5.9 minutes). The researchers estimate that a complete treatment cycle of IV trastuzumab would require 8.2 hours of provider time, while a complete treatment cycle of SC trastuzumab would require 4 hours.

SC trastuzumab for 18 cycles for 1 patient was estimated to save €121.57 ($143.39) in provider time costs, €112.52 ($132.72) in consumables, and €745.51 ($879.31) in the cost of trastuzumab (measured by reported ex-factory price). In terms of indirect costs (lost productivity), SC trastuzumab reduced per-patient costs for an 18-cycle treatment by €152.83 ($180.26). SC trastuzumab provided an overall cost savings (including direct and indirect costs) of €1132.43 ($1335.68).

The researchers concluded that SC trastuzumab could reduce provider and patient time, and could thereby improve patients’ quality of life and produce cost savings for the Spanish health system. The researchers estimate that 4000 to 5000 women in Spain could be eligible for treatment with trastuzumab for early breast cancer, and the savings realized through SC administration could total as much as €4 million ($4.72 million).