Organizational and Environmental Impact of Switching From Intravenous to Subcutaneous Immune Checkpoint Inhibitors (ICIs) in France: A Real-World Analysis Using PMSI Data
Author(s)
Nicolas Virely, MSc1, Marine Sivignon, PharmD2, Rahma Sellami, PharmD1, Charlène Tournier, MSc2, Christos CHOUAID, MD3.
1Putnam, Paris, France, 2Putnam, Lyon, France, 3CHI Créteil France, Créteil, France.
1Putnam, Paris, France, 2Putnam, Lyon, France, 3CHI Créteil France, Créteil, France.
OBJECTIVES: Subcutaneous (SC) formulations of immune checkpoint inhibitors (ICIs) offer a promising alternative to intravenous (IV) administration with potential benefits in organizational efficiency, economic sustainability, and environmental impact. This study aimed to quantify these benefits associated with transitioning from IV to SC administration of the four most prescribed ICIs: pembrolizumab, nivolumab, durvalumab, and atezolizumab in France’s ambulatory care setting.
METHODS: National-level hospital activity data from the 2022 French national hospital data (PMSI) were used to estimate ambulatory visits related to IV ICIs administration across cancer types. The environmental analysis covered carbon emissions from drug preparation, administration and patient travel. Organizational impact was assessed via time spent by healthcare professionals (HCPs) and/or patients. They were monetized using HCP average public hospital salaries and the French minimum wage for patients. Time savings for patients were also converted into average avoidable IV sessions. CO₂ emissions were monetized using the France’s official valuation. Scenarios were developed based on varying IV-to-SC switch rates.
RESULTS: A total of 856,104 hospital stays were extracted from PMSI. A 50% shift from IV to SC administration would free up 3,508 HCP hours and 3,181 patient hours per year. These time savings are equivalent to 190,885 ambulatory visits yearly. These efficiencies correspond to €84.9 million in released day-care capacity, €65,061 in HCP salary savings and €29,905 in patient time value per year. Additionally, the strategy would avert 736 tons of CO₂-equivalent emissions, representing an environmental value of €188,496 per year.
CONCLUSIONS: Broad implementation of SC ICIs formulations in ambulatory care may substantially improve hospital efficiency, lower environmental impact, and alleviate financial pressures on the French healthcare system. These findings are especially relevant in the post-pandemic context of rising outpatient demand, workforce constraints, and increasing emphasis on sustainable healthcare practices.
METHODS: National-level hospital activity data from the 2022 French national hospital data (PMSI) were used to estimate ambulatory visits related to IV ICIs administration across cancer types. The environmental analysis covered carbon emissions from drug preparation, administration and patient travel. Organizational impact was assessed via time spent by healthcare professionals (HCPs) and/or patients. They were monetized using HCP average public hospital salaries and the French minimum wage for patients. Time savings for patients were also converted into average avoidable IV sessions. CO₂ emissions were monetized using the France’s official valuation. Scenarios were developed based on varying IV-to-SC switch rates.
RESULTS: A total of 856,104 hospital stays were extracted from PMSI. A 50% shift from IV to SC administration would free up 3,508 HCP hours and 3,181 patient hours per year. These time savings are equivalent to 190,885 ambulatory visits yearly. These efficiencies correspond to €84.9 million in released day-care capacity, €65,061 in HCP salary savings and €29,905 in patient time value per year. Additionally, the strategy would avert 736 tons of CO₂-equivalent emissions, representing an environmental value of €188,496 per year.
CONCLUSIONS: Broad implementation of SC ICIs formulations in ambulatory care may substantially improve hospital efficiency, lower environmental impact, and alleviate financial pressures on the French healthcare system. These findings are especially relevant in the post-pandemic context of rising outpatient demand, workforce constraints, and increasing emphasis on sustainable healthcare practices.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE603
Topic
Economic Evaluation, Health Service Delivery & Process of Care
Topic Subcategory
Novel & Social Elements of Value
Disease
Oncology