Background Trastuzumab is a monoclonal antibody used to treat HER2 positive breast cancers. Initially, only intravenous trastuzumab (IT) was available until the EMA authorised subcutaneous trastuzumab (ST) in 2013. The posology of IT depends on the patient’s weight whereas the posology of ST is fixed (600 mg).
Purpose Comparison of times (preparation, nurse and medical) and costs.
Material and methods Preparation time in isolators and administration time were measured for 4 weeks. Times were converted to costs with the average salary scale of the hospital. Then, the costs of medical devices used were compared. The results were extrapolated to 1 year.
Results By switching IT to ST, the average preparation time was reduced by 76.2% (500 s (SD 166.0) vs 119.2 s (SD 29.2)) for the loading dose and by 69.3% (387.6 s (SD 109.7) vs 119.2 s (SD 29.2)) for the maintenance dose. This reduction could be explained by the galenic formulation (powder to ready to use solution) and the higher concentration of ST (use of a single vial vs minimum of 3 for IT). In 2015, our hospital prepared 983 ST and 743 IT: an estimated economy of 73.3 hours, or €2420.34. The average nurse time was also reduced: 55.4% (15.7 min (SD 13.1) vs 7 min (SD 1.2)). This could lead to an economy of 137.20 hours or €5327.40 in 2015. The medical time was similar with both forms. The costs of medical devices were reduced from €655 to €240. This could lead to a saving of €4079.45 in 2015. Moreover, the fixed dose of ST and its physicochemical stability enables administration of a non-used treatment to any patient. This has represented an economy of €20669.42 in 2015 (almost 15 administrations of ST). Overall, the use of ST could lead to an economy of €32 496.61 in 2015.
Conclusion The use of ST seems to lead to a saving of time and costs. The most interesting savings concern handling and infusion devices and the possibility of reusing non-administered drugs. However, the pharmaceutical staff have to manage the risk of confusion between these two drugs.
No conflict of interest
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