REAL-WORLD TIME AND COSTS ASSOCIATED WITH PREPARATION AND ADMINISTRATION OF SUBCUTANEOUS (SC) VS. INTRAVENOUS (IV) NIVOLUMAB FOR CANCER TREATMENT
Author(s)
David Crosby, PharmD1, Robert Daly, MD2, Rose DiMarco, PharmD3, Victoria Forte, MD4, Lisa Long, PharmD5, Colleen McCabe, PharmD6, Ultan Mcglone, PharmD7, Ashley Miles, MSN, OCN8, Mikaela Olsen, DNP, MS9, Bradley Rassuchine, PharmD10, Kaitlyn Rawden, PharmD11, Priya Rudolph, MD11, Raji Shameem, MD12, Jennifer Webster, MSN11, Andrew Descoteaux, MS13, Sarah Crisci, MS, MPH14, Karishma Shelley, MS, PharmD15, Eileen Han, PhD16, Ruchi Shah, PharmD17, Aida Kuzucan, PharmD, PhD13, Ariel Berger, MPH18.
1Dartmouth Cancer Center, Lebanon, NH, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA, 3Thomas Jefferson University Hospital, Philadelphia, PA, USA, 4Richmond University Medical Center, Staten Island, NY, USA, 5Georgia Cancer Specialists, Metairie,, LA, USA, 6Vanderbilt University, Nashville, TN, USA, 7University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 8Thomas Jefferson University, Philadephia, PA, USA, 9The Johns Hopkins Health System, Baltimore, MD, USA, 10Comprehensive Cancer Centers of Nevada, Las Vegas, NV, USA, 11Georgia Cancer Specialists, Atlanta, GA, USA, 12Orlando Health Cancer Institute, Orlando, FL, USA, 13PPD a part of Thermo Fisher Scientific, Waltham, MA, USA, 14PPD a part of Thermo Fisher Scientific, Doylestown, PA, USA, 15BMS, Edison, NJ, NJ, USA, 16BMS, Lawrenceville, NJ, USA, 17Bristol Myers Squibb, Princeton, NJ, USA, 18Thermo Fisher Scientific, Waltham, MA, USA.
1Dartmouth Cancer Center, Lebanon, NH, USA, 2Memorial Sloan Kettering Cancer Center, New York, NY, USA, 3Thomas Jefferson University Hospital, Philadelphia, PA, USA, 4Richmond University Medical Center, Staten Island, NY, USA, 5Georgia Cancer Specialists, Metairie,, LA, USA, 6Vanderbilt University, Nashville, TN, USA, 7University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 8Thomas Jefferson University, Philadephia, PA, USA, 9The Johns Hopkins Health System, Baltimore, MD, USA, 10Comprehensive Cancer Centers of Nevada, Las Vegas, NV, USA, 11Georgia Cancer Specialists, Atlanta, GA, USA, 12Orlando Health Cancer Institute, Orlando, FL, USA, 13PPD a part of Thermo Fisher Scientific, Waltham, MA, USA, 14PPD a part of Thermo Fisher Scientific, Doylestown, PA, USA, 15BMS, Edison, NJ, NJ, USA, 16BMS, Lawrenceville, NJ, USA, 17Bristol Myers Squibb, Princeton, NJ, USA, 18Thermo Fisher Scientific, Waltham, MA, USA.
OBJECTIVES: A previous study using time-driven activity-based costing (TDABC) methodology assessed time and costs associated with intravenous (IV) vs. subcutaneous (SC) nivolumab administration based on a panel of healthcare professionals (HCPs) with clinical trial experience. Following US FDA approval of SC nivolumab, this study evaluated real-world differences in HCP time and costs associated with IV versus SC nivolumab administration.
METHODS: A US-based panel of 14 HCPs (7 pharmacists, 4 oncologists, 3 nurses) from multiple institutions participated in structured discussions. Panelists refined previously developed process maps for IV and SC treatment episodes, and provided estimates of resource utilization, including personnel, equipment, medications, and physical space, along with the corresponding time required of each activity within a treatment episode, consistent with TDABC methodology. Resource and time estimates were consensus-driven; associated unit costs were derived from publicly available US sources.
RESULTS: Total preparation and administration time was expected to decrease by 56.6% with SC versus IV nivolumab (41.0 minutes [range: 31.0-105.0] vs. 94.5 minutes [range: 79.5-214.0)), with an absolute 50.0-minute reduction in patient visit time. Savings were attributable to expected reductions in time required by registered nurses (32.1% less time), licensed practical nurse (42.8%) and pharmacy staff (58.3%). These efficiencies translated to an estimated $90 reduction in institutional cost per treatment episode (IV: $9,715 [$9,680-$9,830] vs. SC: $9,625 [$9,597-$9,731]). All other process steps (e.g., patient arrival, pre-treatment evaluation) were deemed by the panelists to be invariant between IV and SC administration.
CONCLUSIONS: In real-world practice, SC nivolumab administration was associated with substantially reduced HCP time, and lower administration-related costs, compared with IV administration. Transitioning from IV to SC administration improves workflow efficiencies, resulting in shorter patient visit duration, and potentially meaningful reductions in resources required by institutions to treat patients.
METHODS: A US-based panel of 14 HCPs (7 pharmacists, 4 oncologists, 3 nurses) from multiple institutions participated in structured discussions. Panelists refined previously developed process maps for IV and SC treatment episodes, and provided estimates of resource utilization, including personnel, equipment, medications, and physical space, along with the corresponding time required of each activity within a treatment episode, consistent with TDABC methodology. Resource and time estimates were consensus-driven; associated unit costs were derived from publicly available US sources.
RESULTS: Total preparation and administration time was expected to decrease by 56.6% with SC versus IV nivolumab (41.0 minutes [range: 31.0-105.0] vs. 94.5 minutes [range: 79.5-214.0)), with an absolute 50.0-minute reduction in patient visit time. Savings were attributable to expected reductions in time required by registered nurses (32.1% less time), licensed practical nurse (42.8%) and pharmacy staff (58.3%). These efficiencies translated to an estimated $90 reduction in institutional cost per treatment episode (IV: $9,715 [$9,680-$9,830] vs. SC: $9,625 [$9,597-$9,731]). All other process steps (e.g., patient arrival, pre-treatment evaluation) were deemed by the panelists to be invariant between IV and SC administration.
CONCLUSIONS: In real-world practice, SC nivolumab administration was associated with substantially reduced HCP time, and lower administration-related costs, compared with IV administration. Transitioning from IV to SC administration improves workflow efficiencies, resulting in shorter patient visit duration, and potentially meaningful reductions in resources required by institutions to treat patients.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD39
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Oncology