OBJECTIVES

: Subcutaneously administered oncology therapies can reduce healthcare resource utilization, improve treatment convenience, and tend to be favored by patients, compared to intravenous administration. However, the ideal method for evaluating this added value is unclear. This review assessed economic evaluations of subcutaneous oncology therapies transitioning from intravenous administration and examined HTA bodies’ responses.

METHODS

A structured literature review was conducted of HTA recommendations on oncology therapies that have transitioned from intravenous to subcutaneous administration: trastuzumab, rituximab, alemtuzumab, bortezomib, daratumumab, pertuzumab, and ocaratuzumab. The review included HTA recommendations from Australia, Canada, France, Italy, Spain, UK, and US. This was supplemented by a review of published literature (2008–present).

RESULTS

: HTA recommendations were identified only for trastuzumab, rituximab, and bortezomib; the majority included budget impact (BI) and cost-minimization (CM) analyses and reported equal efficacy and drug price across both types of administrations. All but one recommendation (for rituximab in Australia) reported cost-savings or cost-neutrality for subcutaneous administration and led to positive reimbursement decisions. Similarly, in published literature, subcutaneous trastuzumab and rituximab incurred lower direct and indirect drug administration costs. Subcutaneous administration was preferred by patients and nursing professionals; time saving was the main reason for patient preference. Subcutaneous administration significantly reduced time of drug preparation, chair time, and clinic occupational costs.

CONCLUSIONS

: CM and BI analyses are the most commonly-used economic evaluations of reimbursement submissions for subcutaneously administered oncology therapies. However, this is a conservative approach which may underestimate value, as additional benefits of subcutaneous administration, such as increased patient preference, may translate to higher quality-adjusted life-year (QALY) benefits that are not being captured in current health economic evaluations. Future modelling methods should consider these benefits in order to appropriately demonstrate the full value of subcutaneously administered oncology therapies.