Comparing Ancillary Services Associated With Subcutaneous Versus Intravenous Medication Administration

OBJECTIVES: New drug delivery technologies which offer alternative routes of administration (ROA) have recently come onto the market and increased in use. Subcutaneous (SC) drug delivery has been shown in single center studies and other, limited real-world studies to demonstrate benefits relative to their intravenous (IV) infusion versions. This retrospective study analyzed the costs associated with IV versus SC versions of a select set of drugs with established history of use in US Medicare Fee for Service.

METHODS: We used the 100% Medicare Research Identifiable Files from 2017 to 2023. We identified Part B medications available both by IV and SC ROA. We identified over 4MM claims from the 8 drugs which treated inflammatory diseases, cancer, and autoimmune indications. Ancillary services assessed: observation services, procedure codes directly related to the administration of the medication, and revenue center billing (i.e. providers operational charges). Distance beneficiaries traveled to providers was assessed. Secondary analysis was restricted to beneficiaries with a single ROA during their treatment. Differences in direct costs associated with SC versus IV drug administrations were also evaluated. Additional patient demographic breakouts (age, race, rural vs urban) were also explored for beneficiaries with a single ROA. Additional longitudinal comparisons of beneficiaries on a single ROA were further explored.

RESULTS: Patient observation time was rarely reported (~2% of claims). Daratumumab-IV had significantly higher operational charges than SC ($127 vs $9, P<0.001) as did pertuzumab/trastuzumab/hyaluronidase IV compared with pertuzumab/trastuzumab/hyaluronidase SC ($120 vs $66, P<0.001). All others showed smaller differences between SC and IV. Except for 1 drug, distance (miles) traveled was equivalent across all drugs because they are HCP-administered at the same center.

CONCLUSIONS: When an alternative ROA is available for a medication delivery, this work demonstrates that in US Medicare some SC drugs offer a lower economic burden in ancillary services accrued during the course of treatment.