PB2294 COST-MINIMIZATION AND BUDGET IMPACT ANALYSIS OF MABTHERA SUBCUTANEOUS FORMULATION IN NON-HODGKIN'S LYMPHOMA (NHL): A CASE STUDY FROM TUNISIA
Authors: R. Ben Lakhal, K. Kacem, M. Raoudha, D. Jabeur, M. S. Denguir, H. Bouattour, B. Meddeb
Journal: HemaSphere (2019)

Background: Intravenously (IV) administered MabThera is the backbone therapy of B NHL. Subcutaneous (SC) administered MabThera formulation promises to reduce administration cost, allowing health resources to be allocated elsewhere thereby reducing burden in the health system. In Tunisia, there is a limited experience with SC Mabthera formulation (a single clinical experience in MabRella trial, local open-label, single-arm, phase IIIb study)[1]. Aims: The aim of the study is to evaluate cost and resource use impact associated with the administration of MabThera SC and IV administrations on the Tunisian health system over three years. Methods: A cost-minimization model was developed to compare all costs (drug and non-drug costs) associated with MabThera SC and MabThera IV. In addition, a budget-impact model was developed to assess the net cost impact of drug acquisition and administration (including hospital and physician services) when switching from MabThera IV to SC over three years. For each year, the budget impact is calculated for three scenarios: Scenario I (With MabThera IV): This is the existing scenario in which MabTheraSC is unavailable in the market; Scenario II (With MabThera SC): In this scenario, it was assumed that MabThera SC has been introduced in the Tunisia market with all patients shifting towards MabThera SC; Scenario III (With mixture of MabThera IV and SC): In this scenario, patients share in Year 1 – SC 25%, IV 75%, Year 2 – SC 50%, IV 50% and Year 3 – SC 75%, IV 25% were assumed. A survey was conducted to collect data on real world MabThera IV and SC administration process at the hematology day care unit and Pharmacy of Hospital Aziza Othmana, Tunis. Finally, a capacity analysis was conducted to evaluate the impact on annual nursing and chair time when switching from IV to SC. Results: Mabthera SC formulation was associated with a cost saving of 41.6% (241 TND) per patient as estimated between MabThera IV (545 TND) and SC (330 TND) for non-drug related costs. The scenario II resulted in a budget savings of 39.3% when estimated in three years. Whereas, the scenario III led to a total cost reduction of 9.8%, 19.7% and 29.5% in year 1, year 2 and year 3, respectively. The capacity analysis showed that the annual chair time is reduced by 193.5 days per year if IV formulation is completely replaced by SC formulation as per scenario II. However, in scenario III where IV is replaced by 80% SC, annual chair time is reduced by 154.8 days per year. Similarly, annual nursing time is reduced by 22.13 days per year if IV is completely replaced by SC. Whereas, as per scenario III where IV is replaced by 80% SC nursing time is reduced by 17.7 days per year. Summary/Conclusion: Our current study shows for the first time that switching NHL patients from MabThera IV to MabThera SC, in the context of a Tunisian healthcare setting, is not only more convenient but also economically beneficial. 1[Panizo C, et al. Safety of subcutaneous administration of rituximab during the first-line treatment of patients with non-Hodgkin lymphoma: the MabRella study. ASH 2016 (Abstract 2971)]