Presentation (CTI)

OBJECTIVES: Subcutaneous (SC) ocrelizumab shortens administration time and, at initiation, halves the number of injections versus the intravenous (IV) route. In a day hospital with limited and multi-tasking nursing staff and chair occupancy, this study quantified the nursing and chair occupancy time released by a full switch to SC, and the additional treatment capacity and activity it would generate.
METHODS: At Lille University Hospital, a monthly cohort of 77 ocrelizumab patients (61 IV maintenance, 13 IV initiation, 3 SC) was modelled under a full-SC scenario at constant volume, valuing shorter injections and one fewer injection at initiation. Resource use, administration, and patient flow were sourced from hospital staff; reimbursement was valued at public tariffs.
RESULTS: In the actual scenario, treating IV patients required 87 injections consuming 224.8 nursing hours and 590.1 chair occupancy hours. A full switch to SC reduced total injections to 74 (-15%), nursing time by 59% (to 92.5 hours; 132 hours released) and chair occupancy time by 80% (to 119.6 hours; 470 hours released). Per injection, nursing time fell from 2.6 to 1.3 hours (-52%) and chair occupancy time from 6.8 to 1.6 hours (-76%). The reduction was larger at initiation (-76% nursing, -88% chair occupancy) than during maintenance (-52% and -76%), reflecting both shorter injections and one fewer injection per initiating patient. The 13 initiating patients alone accounted for 50.9 of the 132 nursing hours released. The released nursing time allowed 105 additional SC injections at constant resources, representing EUR 43,163 in potential reimbursement and equivalent to treating substantially more patients without expanding staff or chair capacity, contingent on neurologists' capacity to absorb the corresponding consultations.
CONCLUSIONS: Subcutaneous administration could reduce the nursing workload compared with IV administration and help optimise day-hospital schedules, freeing capacity for new patients or other care activities.