OBJECTIVES: The rituximab component of the R-CHOP regimen for non-Hodgkin’s lymphoma (NHL) consists of an intravenous (IV) initiation administration in cycle 1 followed in subsequent cycles by either: IV standard infusion (IVS) or 90-minute (m) rapid-infusion (IVR90), or subcutaneous (SC) administration in eligible patients. IV may be with reference rituximab or a proposed biosimilar rituximab. SC rituximab may offer time and cost savings; biosimilar rituximab offers another potential cost-saving option. We performed a time-and-cost simulation of reference IV, SC, and biosimilar IV rituximab from the US payer perspective.

METHODS: Simulation analysis for one NHL patient over six cycles of R-CHOP using: [1] label-recommended administration times for all R-CHOP agents, [2] rituximab 1Q2018 wholesale acquisition cost (WAC, US$), and [3] 2018 reimbursement per Current Procedural Terminology codes (US$). Costs for the proposed biosimilar rituximab were extrapolated at 5% decrements of reference rituximab WAC from 15%-35%. IV simulations were replicated for 3 BSA-adjusted doses: small (1.6m), average (1.85m) and large (2.1m) patients.

RESULTS: Following cycle 1 IV rituximab, switching to SC for subsequent cycles (2-6) saves 650m (or 2h10m/cycle) compared to IVS if BSA=1.6m, 720m (2h24m/cycle) if BSA=1.85m, and 791m (2h38m/cycle) if BSA=2.1m, R-CHOP treatment costs were $4,261 higher if switched to SC compared to IVS and $4,420 higher versus IVR90; if BSA=1.85m, costs for SC were $27 and $185 higher, respectively; if BSA=2.1m, SC saved $4,208 and $4,050, respectively. R-CHOP treatment costs with SC rituximab administration were higher than rituximab biosimilar IVS and IVR90 at all BSA and at all decrements of biosimilar discounts (range: $1,128 to $13,905).

CONCLUSIONS: Conversion from reference rituximab IV to SC saves administration time but not costs except if BSA=2.1m