Optimizing HER2+ Breast Cancer Treatment Pathways in Italian Oncological Centers
Author(s)
Carla Fornari, PhD1, Giorgia Gribaudo, MD1, Ippazio Cosimo Antonazzo, PhD1, Daniele Generali, Prof2, Carlo Carnaghi, MD3, Alessandro Galimberti, Phd4, Patrizia Nardulli, PharmD5, Monica Calamai, MD6, Lorenzo G Mantovani, ScD1, Paolo Angelo Cortesi, PhD1.
1Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy, 2Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy, 3UO Oncologia e Ematologia, Humanitas Istituto Clinico Catanese, Misterbianco, Italy, 4IRCCS Humanitas Research Hospital, Rozzano, Italy, 5IRCCS Istituto Tumori “Giovanni Paolo II, Bari, Italy, 6Ausl Ferrara, Ferrara, Italy.
1Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy, 2Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy, 3UO Oncologia e Ematologia, Humanitas Istituto Clinico Catanese, Misterbianco, Italy, 4IRCCS Humanitas Research Hospital, Rozzano, Italy, 5IRCCS Istituto Tumori “Giovanni Paolo II, Bari, Italy, 6Ausl Ferrara, Ferrara, Italy.
OBJECTIVES: Human Epidermal Growth Factor Receptor 2-positive (HER2+) breast cancer represents a significant burden in terms of female cancer prevalence and healthcare resource utilization in Italy. Despite notable therapeutic advancements, ensuring economic sustainability and operational efficiency remains a critical challenge for the Italian National Healthcare Service. This study aimed to evaluate the managerial and economic implications of different therapeutic administration pathways for HER2+ breast cancer patients, with the goal of optimizing hospital workflows, improving resource allocation, and enhancing patient outcomes across Italian oncology centers.
METHODS: This project developed a decision-tree model to simulate and compare five treatment administration pathways in HER2+ breast cancer patients within Italian hospital settings: Standard (endovenous - EV - formulation only), Drug-Change (introducing subcutaneous - SC - formulation), Drug Day (with time-based improvements), Dedicated Ambulatory (with spatial optimization), and Optimal Pathway (integrating major achievable improvement actions). The model simulates patient and healthcare professional (HCP) activity and waiting times, infusion chair occupation, and direct and indirect costs. Sensitivity analyses assessed variability in model outcomes.
RESULTS: Switching from EV to SC formulation substantially reduced patient crossing times and HCP workloads, thereby freeing up hospital resources. The Optimal Pathway scenario yielded the highest efficiency gains, reducing HCP activity time by up to 48 hours, infusion chair occupational time by up to 150 hours, and patients’ crossing time by up to 753 hours per 100 patients monthly. Cost analyses indicated significant savings in societal and HCP’s work costs, partially offsetting the increase in drug acquisition cost with the SC formulation.
CONCLUSIONS: The adoption of SC formulations, combined with innovative pathway optimizations, enhances treatment efficiency despite a slight increase in overall costs. These findings highlight the importance of tailoring administration strategies to the structural and organizational characteristics of individual oncology centers, in alignment with ongoing reforms within the Italian healthcare system.
METHODS: This project developed a decision-tree model to simulate and compare five treatment administration pathways in HER2+ breast cancer patients within Italian hospital settings: Standard (endovenous - EV - formulation only), Drug-Change (introducing subcutaneous - SC - formulation), Drug Day (with time-based improvements), Dedicated Ambulatory (with spatial optimization), and Optimal Pathway (integrating major achievable improvement actions). The model simulates patient and healthcare professional (HCP) activity and waiting times, infusion chair occupation, and direct and indirect costs. Sensitivity analyses assessed variability in model outcomes.
RESULTS: Switching from EV to SC formulation substantially reduced patient crossing times and HCP workloads, thereby freeing up hospital resources. The Optimal Pathway scenario yielded the highest efficiency gains, reducing HCP activity time by up to 48 hours, infusion chair occupational time by up to 150 hours, and patients’ crossing time by up to 753 hours per 100 patients monthly. Cost analyses indicated significant savings in societal and HCP’s work costs, partially offsetting the increase in drug acquisition cost with the SC formulation.
CONCLUSIONS: The adoption of SC formulations, combined with innovative pathway optimizations, enhances treatment efficiency despite a slight increase in overall costs. These findings highlight the importance of tailoring administration strategies to the structural and organizational characteristics of individual oncology centers, in alignment with ongoing reforms within the Italian healthcare system.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE601
Topic
Economic Evaluation, Health Service Delivery & Process of Care
Disease
Oncology