OBJECTIVES: Subcutaneous (SC) formulations became recently available for several oncology drugs historically administered intravenously (IV). We investigated healthcare and societal costs of SC and IV administration of two oncology drugs in The Netherlands.

METHODS: Data were collected for the preparation and administration of IV and SC trastuzumab (HER2+ metastatic breast cancer) and rituximab (non-Hodgkin lymphoma) at the hospital pharmacy and oncology daycare unit in six Dutch hospitals. For each patient, we registered healthcare professional time, patient chair time, and use of drugs and disposables. Patients completed questionnaires regarding productivity losses, informal care and travelling expenses. Costs were valued using the Dutch costing manual. Costs for time spent at the daycare were computed using the financial administration of participating hospitals.

RESULTS: A total of 82 patients received trastuzumab (37 IV and 45 SC) and 44 patients received rituximab (23 IV and 21 SC). The largest costs were drug costs (€2000 for IV and €1828 for SC). Costs for one administration (excluding drug costs) were €167 and €264 for IV and €76 and €146 for SC trastuzumab and rituximab, respectively. For both drugs, SC administration resulted in €79 lower healthcare and €26 lower societal costs. The largest costs were owing to time spent at the daycare unit (€96 for IV and €38 for SC). Other savings were related to use of consumables (€12) and time of healthcare professionals (€9). Compared to IV administration, SC administration could generate €11 million savings in The Netherlands (€3.7 million for trastuzumab and €7.3 million for rituximab).

CONCLUSIONS: Compared to oncology drug costs, administration costs are relatively small. Important savings can, however, be generated by switching to SC administration because of the large number of administrations. It is essential to optimize the allocation of scarce resources either by changing the route of administration and/or by switching to less costly biosimilar equivalents.