title: Societal cost of subcutaneous and intravenous trastuzumab for HER2-positive breast cancer - An observational study prospectively recording resource utilization in a Swedish healthcare setting.
abstract: BACKGROUND
  Trastuzumab is part of the standard treatment for HER2-positive breast cancer. The aim of this study was to estimate the societal value of trastuzumab administered through subcutaneous (SC) injection compared to intravenous (IV) infusion.
  
  
  METHODS
  Female patients with HER2-positive breast cancer receiving SC or IV trastuzumab were consecutively enrolled from five Swedish oncology clinics from 2013 to 2015. Data on time and resource utilization was collected prospectively using patient and nurse questionnaires. Societal costs were calculated by multiplying the resource use by its corresponding unit price, including direct medical costs (pharmaceuticals, materials, nurse time, etc.), direct non-medical costs (transportation) and indirect costs (production loss, lost leisure time). Costs were reported separately for patients receiving trastuzumab for the first time and non-first time ("subsequent treatment").
  
  
  RESULTS
  In total, 101 IV and 94 SC patients were included in the study. The societal costs were lower with SC administration. For subsequent treatments the cost difference was €117 (IV €2099; SC €1983), partly explained by a higher time consumption both for nurses (14 min) and patients (23 min) with IV administration. Four IV and 16 SC patients received trastuzumab for the first time and were analysed separately, resulting in a difference in societal costs of €897 per treatment. A majority of patients preferred SC to IV administration.
  
  
  CONCLUSIONS
  SC administration resulted in both less direct medical costs and indirect costs, and was consequently less costly than IV administration from a societal perspective in a Swedish setting.
authors: IHE, The Swedish Institute for Health Economics, Box 2127, SE-220 20 Lund, Sweden; Department of Clinical Sciences, Lund University, Sweden. Electronic address: so@ihe.se.
authors: Sara
authors: S
authors: Olofsson
authors: IHE, The Swedish Institute for Health Economics, Box 2127, SE-220 20 Lund, Sweden. Electronic address: hn@ihe.se.
authors: Hanna
authors: H
authors: Norrlid
authors: Department of Oncology, Skåne University Hospital, SE-221 85 Lund, Sweden. Electronic address: eva.u.karlsson@skane.se.
authors: Eva
authors: E
authors: Karlsson
authors: Karolinska Institutet, Department of Oncology-Pathology, Karolinska University Hospital Solna, Z1:00, SE-171 76 Stockholm, Sweden. Electronic address: ulla.wilking@ki.se.
authors: Ulla
authors: U
authors: Wilking
authors: IHE, The Swedish Institute for Health Economics, Box 2127, SE-220 20 Lund, Sweden. Electronic address: grt@ihe.se.
authors: Gunnel
authors: G
authors: Ragnarson Tennvall
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics*; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007279:Injections, Subcutaneous; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013548:Sweden; D000068878:Trastuzumab / Q000008:administration & dosage / Q000191:economics*
chemical_list: D000970:Antineoplastic Agents; D000068878:Trastuzumab
keywords: HER2-positive breast cancer; Intravenous; Resource use; Societal cost; Subcutaneous; Trastuzumab