Abstract P4-21-15: Trastuzumab IV versus SC: A time, motion and cost assessment in a lean operating day care oncology unit
Authors: Tjalma WAA , Van den Mooter T , Mertens T , Bastiaens V , Altintas S , Huizing MT , Trinh B , Van Dam P , Peeters M , Papadimitriou K 
Published: March 2017

Abstract
Purpose:
Primary endpoint: quantification of the active healthcare professional (HCP) time associated with the standard intravenous (IV) infusion of trastuzumab (Herceptin®) compared to the subcutaneous (SC) administration in the treatment of patients with HER2-positive early breast cancer.
Secondary endpoints: quantification of the preparation and administration related costs (HCP time, consumables and drug wastage), patient chair time and the total time spent in the day care unit for both routes of administration.
Patients and Methods:
A local observational project was conducted in the LEAN Operating Day Care Oncology Unit of the Antwerp University Hospital (Belgian registration number: B300201525036).
Independent trained observers measured the duration of each trastuzumab IV and SC related task that HCPs undertook and recorded patient time in the chair and the day care unit. The type and quantity of medical consumables used with each route of administration were also registered. A total of 105 patient episodes were recorded (40 IV, 65 SC) from October 2015 until May 2016.
The recorded active HCP time corresponded to the active preparation and administration time of the medication. Total preparation and administration time was calculated as the mean sum of task times, both for IV and SC formulations. The cost of each route of administration was calculated as the mean cost of HCP time plus the mean cost of consumables used. Drug wastage that occurred with the IV formulation was also taken into account. The total active HCP time was quantified by the Hospital's Human Resources department. Consumables were quantified using hospital pharmacy data and online sources. Patient chair time was measured as the actual time the patient spent on the chair/bed. The total time spent in the day care unit was calculated as the time between the patient's registry and the time the patient left the hospital.
Results: The mean active HCP time for preparation and administration of IV was 64 minutes compared to 14 minutes for SC. The mean cost for preparation and administration was €303,12 for IV (€33,8 of HCP time, €23,56 of consumables and €245,76 of drug wastage) versus €10,39 for SC (€7,68 of HCP time and €2,71 of consumables). Mean patient chair time and the total time spent in the day care unit for IV was 133 minutes and 165 minutes respectively, and 11 minutes and 50 minutes for SC.
Mean administration route per cycleIVSCActive HCP time (minutes)6414Cost HCP time (€)33,87,68Cost consumables (€)23,562,71Drug wastage (€)245,760Patient chair time (minutes)13311Total time spent in the hospital (minutes)16550
SC administration of trastuzumab resulted in a HCP time saving of 50 minutes (versus IV) with a total cost saving of €292,73 per administration. This leads to a potential saving of €5.269,16 over a full course of adjuvant treatment (18 cycles).
Conclusion: Substituting IV with SC administration of trastuzumab leads to a substantial reduction in active HCP time. As a result the overall costs consisting of HCP time, consumables and drug wastage are also reduced. Additionally, the reduced patient chair and unit time could provide increased capacity within existing resources in a LEAN Operating Day Care Oncology Unit.
Citation Format: Tjalma WAA, Van den Mooter T, Mertens T, Bastiaens V, Altintas S, Huizing MT, Trinh B, Van Dam P, Peeters M, Papadimitriou K. Trastuzumab IV versus SC: A time, motion and cost assessment in a lean operating day care oncology unit [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-15.