by Margreet Franken, Tim Kanters, Jules Coenen, Paul de
Jong, Agnes Jager, Carin Uyl-de Groot
The Breast: VOLUME 52, P71-77, AUGUST 01,
2020
Highlights
- Home-based administration of SC trastuzumab almost triples the time of healthcare professionals.
- Healthcare costs are almost twice as much for home-based than for hospital-based administration.
- Patient and family costs are almost five times lower for home-based than for hospital-based administration.
Abstract
Objective
To investigate resource use and time investments of
healthcare professionals, patients and their family and to compare healthcare
and societal costs of one single hospital-based and one single home-based
subcutaneous administration of trastuzumab in The Netherlands.
Method
We conducted a bottom-up micro-costing study. Patients
diagnosed with HER2+ early or metastatic breast cancer were recruited in four
Dutch hospitals. For healthcare costs, data were collected on drug use,
consumables, use of healthcare facilities, time of healthcare professionals,
and travelling distance of the nurse. For societal costs, data were collected
on patient and family costs (including travelling expenses and time of informal
caregivers) and productivity losses of paid and unpaid work.
Results
Societal costs of one single administration of SC
trastuzumab were €1753 within the home-based and €1724 within the
hospital-based setting. Drug costs of trastuzumab were identical in both
settings (€1651). Healthcare costs were higher for home-based administration
(€91 versus €47) mainly because of more time of healthcare professionals (110
versus 38 minutes). Costs for patient and family were, however, lower for
home-based administration due to travelling expenses (€7 versus €0) and time of
informal caregivers (€14 versus €4). Costs for productivity losses were similar
for both settings.
Conclusions
Home-based subcutaneous administration of trastuzumab is
more time consuming for healthcare professionals and therefore more costly than
hospital-based administration. The total budget impact can be large considering
that a large number of patients receive a large number of cycles of oncology
treatments. If home-based administration is the way forward, novel approaches
are crucial for ensuring efficiency of home-based care.
