title: Systematic review of drug administration costs and implications for biopharmaceutical manufacturing.
abstract: BACKGROUND
  The acquisition costs of biologic drugs are often considered to be relatively high compared with those of nonbiologics. However, the total costs of delivering these drugs also depend on the cost of administration. Ignoring drug administration costs may distort resource allocation decisions because these affect cost effectiveness.
  
  
  OBJECTIVE
  The objectives of this systematic review were to develop a framework of drug administration costs that considers both the costs of physical administration and the associated proximal costs; and, as a case example, to use this framework to evaluate administration costs for biologics within the UK National Health Service (NHS).
  
  
  METHODS
  We reviewed literature that reported estimates of administration costs for biologics within the UK NHS to identify how these costs were quantified and to examine how differences in dosage forms and regimens influenced administration costs. The literature reviewed were identified by searching the Centre for Review and Dissemination Databases (DARE, NHS EED and HTA); EMBASE (The Excerpta Medica Database); MEDLINE (using the OVID interface); Econlit (EBSCO); Tufts Medical Center Cost Effectiveness Analysis (CEA) Registry; and Google Scholar.
  
  
  RESULTS
  We identified 4,344 potentially relevant studies, of which 43 studies were selected for this systematic review. We extracted estimates of the administration costs of biologics from these studies. We found evidence of variation in the way that administration costs were measured, and that this affected the magnitude of costs reported, which could then influence cost effectiveness.
  
  
  CONCLUSIONS
  Our findings suggested that manufacturers of biologic medicines should pay attention to formulation issues and their impact on administration costs, because these affect the total costs of healthcare delivery and cost effectiveness.
authors.affiliation: Department of Applied Health Research, EPSRC Centre for Innovative Manufacturing in Emergent Macromolecular Therapies, University College of London, 1-19 Torrington Place, London, WC1E 7HB, UK, e.tetteh@ucl.ac.uk.
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Tetteh
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
mesh_terms: D001688:Biological Products / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D004333:Drug Administration Routes; D016527:Drug Costs; D006801:Humans; D013222:State Medicine / Q000191:economics
chemical_list: D001688:Biological Products