FIXED-DOSE SUBCUTANEOUS RITUXIMAB VERSUS BSA-ROUNDED IV BIOSIMILAR: A COST-CONSEQUENCE ANALYSIS OF AN AS-PRACTICED MIXED FORMULARY AT SSMC A TERTIARY ONCOLOGY CENTRE IN THE MIDDLE EAST
Author(s)
Ammar Abdaljalil, BSc Pharm BCOP PgDip HTA1, Rayan Elamin, MSc, EMBA, CPHQ1, Ameera El Gendy, BSc Pharm BCPS1, Ghulam Mustafa, PharmD1, Lamia Yahya, BSc Pharm BCPS BCNSP1, Marleine Bejjani, PharmD1, Husni Al hateeti, MD,, MSc, MRCP2, Moussab Damlaj, MD FRCPC FACP2, Fatema Al Shehhi, MD2, Waed Jaber, MBBS2, Aydah Alawadhi, MD2.
1Pharmacy, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates, 2Oncology/Hematology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
1Pharmacy, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates, 2Oncology/Hematology, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
OBJECTIVES: To quantify SSMC's as-practiced rituximab pathway, in which first label-mandated dosing used IV biosimilar and subsequent label-eligible doses used fixed-dose SC originator, versus an all-IV biosimilar counterfactual with BSA vial rounding.
METHODS: Single-centre retrospective microcosting of 69 patient sequences and 285 administrations (137 observed IV; 148 observed SC) used SSMC dispensing and visit-time records. Drug inputs used Department of Health Abu Dhabi Pharmacy Price/AWP values. Operational time inputs were IV mean 393 minutes (n=98) and SC mean 208 minutes (n=141). Staff, patient productivity, chair capacity, AE avoidance, IV administration time, and line-care consumables were modelled separately. Parameter uncertainty used 1,000-iteration PSA and +/-20% one-way sensitivity analysis. Costs are reported in AED and 2024 World Bank GDP-PPP international dollars (2.330334 AED/Int$).
RESULTS: The hybrid pathway generated a net cost-consequence surplus of AED 1,095,341 (Int$470,000) versus all-IV biosimilar. Drug acquisition saving was AED 750,546 (Int$322,100), driven by avoided BSA vial-wastage rounding across 216 SC doses. Other contributions were provider staff AED 57,938, patient productivity AED 42,457, and chair capacity AED 244,399 (111.1 six-hour equivalents). A separate AE/IV-administration/line-care credit of AED 47,209 (Int$20,300) raised the combined total to AED 1,142,549 (Int$490,294). PSA mean surplus was AED 1,091,469 (Int$468,374), with 95% CrI AED 830,566-1,351,732 (Int$356,415-580,059), positive in all iterations. The tornado identified IV biosimilar and SC originator drug prices as dominant uncertainty sources; chair-capacity rate was a minor lever (fourth-largest swing, behind the IV biosimilar 100 mg vial price).
CONCLUSIONS: In this UAE cohort, the hybrid pathway generated a positive net cost-consequence surplus versus all-IV biosimilar. Value was driven by avoided BSA vial-wastage on subsequent doses, with additional chair-capacity, staff/patient time, and IV-exposure-related credits. Findings support the hybrid formulary as a locally efficient administration strategy; external adopters should adapt the model to local tender prices, operations, chair use, and AE surveillance.
METHODS: Single-centre retrospective microcosting of 69 patient sequences and 285 administrations (137 observed IV; 148 observed SC) used SSMC dispensing and visit-time records. Drug inputs used Department of Health Abu Dhabi Pharmacy Price/AWP values. Operational time inputs were IV mean 393 minutes (n=98) and SC mean 208 minutes (n=141). Staff, patient productivity, chair capacity, AE avoidance, IV administration time, and line-care consumables were modelled separately. Parameter uncertainty used 1,000-iteration PSA and +/-20% one-way sensitivity analysis. Costs are reported in AED and 2024 World Bank GDP-PPP international dollars (2.330334 AED/Int$).
RESULTS: The hybrid pathway generated a net cost-consequence surplus of AED 1,095,341 (Int$470,000) versus all-IV biosimilar. Drug acquisition saving was AED 750,546 (Int$322,100), driven by avoided BSA vial-wastage rounding across 216 SC doses. Other contributions were provider staff AED 57,938, patient productivity AED 42,457, and chair capacity AED 244,399 (111.1 six-hour equivalents). A separate AE/IV-administration/line-care credit of AED 47,209 (Int$20,300) raised the combined total to AED 1,142,549 (Int$490,294). PSA mean surplus was AED 1,091,469 (Int$468,374), with 95% CrI AED 830,566-1,351,732 (Int$356,415-580,059), positive in all iterations. The tornado identified IV biosimilar and SC originator drug prices as dominant uncertainty sources; chair-capacity rate was a minor lever (fourth-largest swing, behind the IV biosimilar 100 mg vial price).
CONCLUSIONS: In this UAE cohort, the hybrid pathway generated a positive net cost-consequence surplus versus all-IV biosimilar. Value was driven by avoided BSA vial-wastage on subsequent doses, with additional chair-capacity, staff/patient time, and IV-exposure-related credits. Findings support the hybrid formulary as a locally efficient administration strategy; external adopters should adapt the model to local tender prices, operations, chair use, and AE surveillance.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA14
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Health Technology Assessment
Disease
Oncology