title: Home administration of bortezomib in multiple myeloma is cost-effective and is preferred by patients compared with hospital administration: results of a prospective single-center study.
abstract: BACKGROUND
  Subcutaneous (s.c.) administration of bortezomib is the most widely used route of administration for the treatment of patients with multiple myeloma. No study has as yet prospectively evaluated home versus hospital administration of s.c. bortezomib with respect to patient preference and cost.
  
  
  METHODS
  In this prospective trial, myeloma patients received the first administration of s.c. bortezomib of each cycle in the outpatient unit of the Department of Hematology. When possible, all subsequent doses of bortezomib within each cycle were provided at home. A cost analysis was carried out to compare the average cost of an injection of bortezomib in the outpatient unit and at home. In order to compare hospital and home administration of bortezomib for preference and satisfaction, patients had to complete 2 simple questionnaires analyzing 16 criteria, such as quality of life, well-being, social life, satisfaction, safety, quality of care, the reduction in personal transportation time, and personal anxiety. Each item was analyzed using a Likert scale.
  
  
  RESULTS
  Fifty patients were studied. Overall, a total of 1043 s.c. injections of bortezomib were carried out, 655 (62.8%) at home, and 388 (35.2%) in the outpatient unit. The cost analysis showed that the total cost of one s.c. injection of bortezomib in the outpatient unit was €1510.09 versus €1224.57 for the home administration, which represents a reduction of €285.52, i.e. 20% of the cost of the hospital administration. The evaluation of patient preference and satisfaction showed that home administration improved the quality of life in 84% of the patients, increased well-being in 78%, and improved the activities of daily living in 72% of the cases. Overall, 98% of the patients noted their preference for home administration over the hospital administration of bortezomib.
  
  
  CONCLUSIONS
  Home administration of s.c. bortezomib is cost-effective and is preferred by myeloma patients compared with hospital administration.
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Lassalle
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: P
authors.initials: P
authors.lastname: Thomaré
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Fronteau
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: B
authors.initials: B
authors.lastname: Mahé
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Jubé
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: N
authors.initials: N
authors.lastname: Blin
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: M
authors.initials: M
authors.lastname: Voldoire
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: V
authors.initials: V
authors.lastname: Dubruille
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: B
authors.initials: B
authors.lastname: Tessoulin
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Touzeau
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: C
authors.initials: C
authors.lastname: Chauvin
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: M
authors.initials: M
authors.lastname: Loirat
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: A
authors.initials: A
authors.lastname: Lok
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: J
authors.initials: J
authors.lastname: Bourcier
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: E
authors.initials: E
authors.lastname: Lestang
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: R
authors.initials: R
authors.lastname: Mocquet
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France.
authors.forename: V
authors.initials: V
authors.lastname: Barbarot
authors.affiliation: Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France philippe.moreau@chu-nantes.fr.
authors.forename: P
authors.initials: P
authors.lastname: Moreau
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000069286:Bortezomib / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000451:nursing; D057240:Patient Preference; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents; D000069286:Bortezomib
keywords: cost analysis; multiple myeloma; quality of life; subcutaneous bortezomib