Bax, P.

Blommestein, H.M.

Hoogendoorn, M.

Hospes, W.

Mihajlović, J.

Postma, M.J.

Van Breugel, E.

English

Background: Rituximab for subcutaneous (SC) administration has recently been approved for use in common forms of diffuse large B-cell lymphoma (DLBCL). This form of rituximab is supplied in ready-to-use vials that do not require individual dose adjustment. It is expected that SC-injection will shorten the treatment time per administration of rituximab in comparison with currently available intravenous (IV) infusion. Aims: The goal of this study is to identify and compare all direct costs of IV and SC rituximab given to the DLBCL patients in the Netherlands. Methods: Using a prospective, observational, bottom up, micro-costing study we collected primary data on the direct medical costs of the preparation, administration and acquisition of rituximab. Drug costs and spillage, labor costs, material costs and remaining daycare costs were identified using standardized forms, structured using guideline prices and compared for the IV and SC forms of rituximab. Results: Measurements were done on 53 administrations (33 IV and 20 SC). The mean total costs of the IV infusion were €2174, and €1907 for the SC injection. The estimated difference of €267 per administration was mainly due to spillage costs and differences in chair time, related daycare costs and drug costs. Summary and Conclusions: Rituximab administered in the form of SC injection is less costly than its IV form. Taking into account their equal effectiveness, favorable pharmacoeconomic profile of SC rituximab can result in significant savings when transferred to the total DLBCL population in the Netherlands

ARTS repository - University of Groningen

   University of GroningenMicro-costing study of rituximab subcutaneous injection versus intravenous infusion in dutchsettingMihajlović, J.; Bax, P.; Van Breugel, E.; Blommestein, H.M.; Hoogendoorn, M.; Hospes, W.;Postma, M.J.Published in:HaematologicaIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2015Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Mihajlović, J., Bax, P., Van Breugel, E., Blommestein, H. M., Hoogendoorn, M., Hospes, W., & Postma, M.J. (2015). Micro-costing study of rituximab subcutaneous injection versus intravenous infusion in dutchsetting. Haematologica, 100, 582.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.to remain effective in controlling demand and thus health spending, so webelieve this tool should be maintained in the coming years to efficiently man-age the requests for erythroid maturation factors.E1453MICRO-COSTING STUDY OF RITUXIMAB SUBCUTANEOUS INJECTIONVERSUS INTRAVENOUS INFUSION IN DUTCH SETTINGJ. Mihajlović1,2,* P. Bax1, E. van Breugel1, H.M. Blommestein3, M. Hoogen-doorn4, W. Hospes5,6, M.J. Postma1,71Unit of PharmacoEpidemiology & Pharmacoeconomics, University ofGroningen, Groningen, Netherlands, 2Mihajlović Health Analytics, Novi Sad,Serbia, 3Erasmus University, Rotterdam, 4Department of Haematology, Med-ical Center Leeuwarden, Leeuwarden, 5Department of Pharmacy, Isala Clin-ics, Zwolle, 6Department of Pharmacy, Ommelander Zorggroep, Win-schoten/Delfzijl, 7Institute of Science in Healthy Aging & health caRE(SHARE), University Medical Center Groningen (UMCG), Groningen, Nether-landsBackground: Rituximab for subcutaneous (SC) administration has recentlybeen approved for use in common forms of diffuse large B-cell lymphoma(DLBCL). This form of rituximab is supplied in ready-to-use vials that do notrequire individual dose adjustment. It is expected that SC-injection will short-en the treatment time per administration of rituximab in comparison with cur-rently available intravenous (IV) infusion.Aims: The goal of this study is to identify and compare all direct costs of IVand SC rituximab given to the DLBCL patients in the Netherlands. Methods: Using a prospective, observational, bottom up, micro-costing studywe collected primary data on the direct medical costs of the preparation,administration and acquisition of rituximab. Drug costs and spillage, laborcosts, material costs and remaining daycare costs were identified using stan-dardized forms, structured using guideline prices and compared for the IVand SC forms of rituximab. Results: Measurements were done on 53 administrations (33 IV and 20 SC).The mean total costs of the IV infusion were €2174, and €1907 for the SCinjection. The estimated difference of €267 per administration was mainlydue to spillage costs and differences in chair time, related daycare costs anddrug costs.Summary and Conclusions: Rituximab administered in the form of SC injec-tion is less costly than its IV form. Taking into account their equal effective-ness, favorable pharmacoeconomic profile of SC rituximab can result in sig-nificant savings when transferred to the total DLBCL population in the Nether-lands.E1454BIOSIMILAR FILGRASTIM FOR THE PREVENTION OF FEBRILE NEU-TROPENIA IN ELDERLY DLBCL PATIENTS HAS COST EFFECTIVENESSCOMPEERED WITH ORIGINAL FILGRASTIMN. Takezako1,* N. Sekiguch1, A. Nagata1, M. Kurimoto1, S. Noto1, A. Miwa11Hematology, Disaster Medical Center of Japan, Tachikawa, JapanBackground: According to American Society of Clinical Oncology guidelineon the use of granulo- colony-stimulating factors (G-CSF), primary prophy-laxis is recommended for the prevention of febrile neutropenia (FN) in patientswho are at high risk based on age, medical history, disease characteristics,and myelotoxicity of the chemotherapy regimen. G-CSF use allows a modestto moderate increase in dose-density and dose-intensity of chemotherapyregimens. Prophylactic G-CSF for patients with diffuse aggressive lymphomaaged 65 years and older treated with R-CHOP should be given to reduce theincidence of FN. A similar biologic medicinal product, commonly referred toas biosimilar, is a copy version of an approved original biologic medicinewhose data protection has expired. Among of them, biosimilar filgrastimhave been approved and become available in Europe on the basis of com-parable quality, safety and efficacy to the originator product. In Japan, biosim-ilar filgrastim approved in 2013. However, biosimilar filgrastim has not beenused widely in Japan though it may have the reduction effect of costs. Herewe investigated the efficacy and the cost saving effect in use of biosimilar fil-grastim.Aims: To evaluate the efficacy and the cost saving effect in use of biosimilarfilgrastim.Methods: From July 2013 to December 2014, our Institution used the biosim-ilar filgrastim (Filgrastim BS®; Mochida Industrial Products, Tokyo, Japan),at dosage of 75µg/day from day +10, for FN prophylaxis and hematologicalrecovery in elderly diffuse large B cell lymphoma (DLBCL) patient whoreceived R-CHOP therapy. These patients were retrospectively comparedwith same elderly patients who received original filgrastim (Gran®; KyowaHakko Kirin Co., Ltd, Tokyo, Japan), at dosage of 75µg/day from day +10 asFN prophylaxis after R-CHOP (from April 2010 to June 2013). Comparisonsbetween qualitative variables were carried out using the χ2 test. Statisticalanalyses were performed with the software package Stata version 11 (StataCorp LP, College Station, TX, USA). In all analyses, P values were 2-tailed,and a P value less than 0.05 was considered to be significant.Results: A total of 102 elderly patients with DLBCL were identified for thisstudy, comprising 41 patients treated with Filgrastim BS® and 61 treated withGran®. Comparisons of patient outcomes between groups are presented inTable 1. There was no statistically significant difference among the two patientcohorts. Mortality during therapy was similar in two group (p=0.647). Fur-thermore, number of injection during one cycle was significant less in Fil-grastim BS® group (4.2 vs 5.0; p <0.001). In addition, mean medical costsduring hospitalization were statistically lower in the Filgrastim BS® groupthan in the Gran® group (1,356.3±94.1 vs 2,357.2±113.4 Euro; p <0.001).Table 1.Summary and Conclusions: According to our study, it is revealed thatbiosimilar filgrastim (Filgrastim BS®) has similar efficacy and safety comparedwith original filgrastim in febrile neutropenia prophylaxis after R-CHOP ther-apy in elderly patients. This data confirm previous evidence that supportsthe non-inferiority of biosimilar filgrastim in this setting. Furthermore, meanmedical costs during chemotherapy were statistically lower in the FilgrastimBS® group than in the Gran® group. E1455IS CLINICAL TRIAGE EFFECTIVE? AN AUDIT OF OUTPATIENT REFER-RALS TO THE HAEMATOLOGY DEPARTMENT AT NORTHWICK PARKHOSPITAL, LONDON NORTHWEST NHS TRUSTM. Camilleri1,* F. Chowdhury11Haematology, Northwick Park Hospital, Harrow, United KingdomBackground: The haematology service at Northwick Park Hospital is knownto be busy, with a minimum of seven follow-up clinics and five new patientclinics running weekly. One Friday afternoon new patient session has beenintroduced last year as a measure to keep up with the new outpatient referralsthat come to the department. In order to manage these referrals better, alocal consultant-led triage system screens and inputs each one onto a com-mon departmental database. Aims: The aim is to increase the efficiency and safety of the outpatient serv-ice by assessing the necessity of each referral and making sure patients areseen within the right time frame by the appropriate clinician.Methods: To assess this, an audit was carried out on all the new outpatientsreferred to the haematology department at Northwick Park Hospital over a 6month period. Data was extracted and analysed using simple descriptive sta-tistical tools available on Microsoft Excel.Results: There were 1016 referrals recorded from July 2014 to December2014, with most cases being triaged within 1 to 3 days on receipt of referral.14% of these were rejected, either because they were deemed inappropriate(41%) or the patient would have benefitted from an alternative specialist review(11%). Out of all the accepted referrals 24% needed the red cell service, 29%required clotting advice and 34% of patients needed review at a white cellclinic. 14% of haematology referrals had no specified reason documented.74% of referrals come from primary care, with 55% coming directly from theGP and another 19% via the Choose and Book patient scheme. The vastmajority of rejected referrals came from primary care (96%) with most clinicalquestions requiring only simple advice, at times given over the phone. 71%were direct GP referrals and 25% were Choose and Book electronic referrals.Triaging cases to avoid unnecessary consultations is very likely to have pos-itive financial implications, considering that costs of GP referrals to the NHScome to £15 billion per year. 156 patients (15%) needed to be seen urgentlywithin a two week period, were the majority were referred due to a white celldisorder (69%). Such cases constitute an average of 40% of a typical newpatient clinic list (2 slots out of 5 per clinic session), with an appreciable num-ber of patients ending up requiring hospital admission for expedited work-up.582 | haematologica | 2015; 100(s1)20thCongress of the European Hematology Association

Micro-costing study of rituximab subcutaneous injection versus intravenous infusion in dutch setting

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Micro-costing study of rituximab subcutaneous injection versus intravenous infusion in dutch setting

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