The Burden of Intravenous vs Subcutaneous Oncological Products Application in Honduras

OBJECTIVES: The administration route of oncological treatments impact the quality of life of patients and costs of the healthcare system. In Honduras, the selection between an intravenous (IV) or a subcutaneous (SC) drug is critical due to limited healthcare resources and treatment accessibility. This study examines the difference in direct costs for treating patients with IV vs SC in a one-year scheme of Trastuzumab every 3 weeks.

METHODS: A Panel Delphi, bottom-up cost analysis was performed with the oncological hospital team (oncologists, cardiologists, nurses & pharmacists) experts from the two principal regions of Honduras (San Pedro Sula and Tegucigalpa). Experts estimated the resource usage in the preparation, application, adverse events and follow up of patients with Trastuzumab IV and SC, calculating the probability and frequency of their use; finally, each expert identified the differences in healthcare processes, avoiding the halo effect. Finally, the costs (USD 2023) were obtained from tariff manuals and those reported by the experts.

RESULTS: The IV application costs USD 2,058.71 per year (18 applications) in comparison with the SC one with USD81.77. The principal difference is due to the preparation and administration of the drug that costs USD 1,877.59 for the 18 applications, followed by the adverse events generated by the peripheral application of the IV (heart failure 5%, phlebitis 20-30%, severe arterial hypertension 3% and cardiomyopathy 1%) which represent USD 203,74 in the same period of time (some of them could last more than a year or become chronic).

CONCLUSIONS: The application of IV oncological therapies is more costly than the SC as per a reduction in the preparation and administration costs, but also in the reduction of adverse events. The use of SC oncological therapies represents an improvement in patients quality of life and reduce the healthcare resources utilization.