Systematic Literature Review of Hospital Time and Resource Consumption in Subcutaneous and Intravenous Oncologic Biologic Therapies: The Case Study of Atezolizumab From an Italian Perspective

OBJECTIVES: Atezolizumab is a monoclonal antibody used in cancer immunotherapy targeting PD-L1 receptors. The subcutaneous (SC) formulation offers a time-efficient alternative to the intravenous (IV) route, as reported in IMscin001 and IMscin002 studies (NCT03735121). To support an economic analysis of atezolizumab SC versus IV from the perspective of Italian hospitals, a systematic literature review (SLR) was conducted to evaluate resource consumption differences between SC and IV administration.

METHODS: Peer-reviewed publications reporting on the active working time of healthcare professionals (HCPs) managing SC and IV administration of oncologic biological therapies were included up to December 2023. Extracted data were statistically combined using a random-effects model. Outcomes (drug preparation time and time spent in the treatment room per patient by HCPs) were summarized as mean and 95% confidence interval (CI).

RESULTS: From over 3,500 identified articles, 22 met the eligibility criteria. The mean active time of pharmacists on drug preparation was 12.4 minutes (95%CI 9.5–15.3) for SC and 20.0 minutes (95%CI 14.7–25.3) for IV therapies. Nurses spent 14.0 minutes (95%CI 12.4–15.6) in the treatment room for SC and 30.6 minutes (95%CI 22.7–38.6) for IV. Considering Italian HCP hourly wages, the annual patients potentially treated (~6,600), and a mean treatment duration across all therapeutic indications of 6.49 months (Q3W schedule), treating with atezolizumab SC could save a yearly average of 25,200 hours (47.8%) of HCP time and €0.676 million (44.7%) compared to IV. However, using infusion times observed in the IMscin001 and IMscin002 studies (7.1 and 30 minutes for SC and IV, respectively) instead of those elaborated in the SLR, the savings associated to atezolizumab SC could increase up to €0.804 million (53.7%) compared to IV.

CONCLUSIONS: Administering atezolizumab SC instead of IV could result in cost savings for Italian hospitals by reducing HCP time for drug preparation and administration, thereby enhancing overall efficiency and financial sustainability.