Background and importance Tocilizumab is a humanised anti-interleukin-6 receptor monoclonal antibody. Intravenous tocilizumab is approved for use in children aged 2 years or older with polyarticular juvenile idiopathic arthritis (PJIA). Recently, subcutaneous tocilizumab was labelled for the same indication, demonstrating efficacy with a similar safety profile as intravenous administration.
Aim and objectives The aim of this study was to analyse treatment costs of subcutaneous tocilizumab (SC-T) versus intravenous tocilizumab (IV-T) in children with PJIA.
Material and methods This was a cross sectional study in a paediatric teaching hospital including all children with PJIA treated with intravenous tocilizumab. Variables collected were: sex, age, weight, posology of IV-T and consumption of vials and monthly cost associated with the use of IV-T. We analysed the potential cost savings if SC-T was used instead of IV-T. Costs were calculated using public prices provided by the health system (349.0€/vial of 200 mg, 244.3€/vial of 80 mg and 139.6€/subcutaneous syringe of 162 mg). The monthly dose of IV-T is 8 mg/kg for patients weighing >30 kg and 10 mg/kg for patients weighing ≤30 kg. The dose of SC-T is 162 mg every 2 weeks in patients weighing >30 kg, and 162 mg every 3 weeks in patients weighing ≤30 kg.
Results Twenty patients were included: 18/20 were female, median age was 12.5 years (IQR 9.5–14.5 years) and median weight was 42.7 kg (IQR 36.4–53.5 kg). In our sample there were no patients weighing <20 kg but it should be noted that in these patients, SC-T was more expensive than IV-T.
Table 1 shows the monthly cost of treatment with intravenous and subcutaneous tocilizumab:
Monthly savings in exclusively using SC-T was €4205.45 (median monthly saving per patient €210.27), which represents a decrease of 30.9% in cost.
Conclusion and relevance The use of subcutaneous tocilizumab in PJIA could represent a considerable saving. Furthermore, subcutaneous administration reduces the treatment burden for patients, self-administration results in fewer absences from school as well as improved resource utilisation at the treatment facility.
References and/or acknowledgements No conflict of interest.
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