title: Cost savings of home bortezomib injection in patients with multiple myeloma treated by a combination care in Outpatient Hospital and Hospital care at Home.
abstract: At home injectable chemotherapy for patients receiving treatment for hematological diseases is still in debate. Given the expense of new innovative medicines, at home treatment has been proposed as a suitable option for improving patient quality of life and decreasing treatment costs. We decided to assess the cost of bortezomib administration in France among multiple myeloma patients from an economic standpoint. Patients in this study were treated within a regional hematological network combining outpatient hospital care and Hospital care at Home administration. To make the cost comparison, our team simulated outpatient hospital care expenses. Fifty-four consecutive multiple myeloma patients who received at least one injection of bortezomib in Hospital care at Home from January 2009 to December 2011 were included in the study. The median number of injections was 12 (range 1-44) at home and 6 (range 0-30) in the outpatient care unit. When compared with the cost simulation of outpatient hospital care alone, bortezomib administration with combined care was significantly less expensive for the National Health Insurance (NHI) budget. The mean total cost per patient and per injection was 954.20 € for combined outpatient and Hospital care at Home vs 1143.42 € for outpatient hospital care alone. This resulted in an estimated 16.5 % cost saving (Wilcoxon signed-rank test, p < 0.0001). The greatest savings were observed in administration costs (37.5 % less) and transportation costs (68.1 % less). This study reflects results for a regionally implemented program for multiple myeloma patients treated with bortezomib in routine practice in a large rural area.
authors.affiliation: Service d'Hématologie Clinique et Thérapie Cellulaire, CHU de Limoges, Limoges, France. mohamed.touati@chu-limoges.fr.|Réseau HEMATOLIM, CHU de Limoges, Limoges, France. mohamed.touati@chu-limoges.fr.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Touati
authors.affiliation: HEVA, Health Evaluation, Lyon, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Lamarsalle
authors.affiliation: Service d'Hématologie Clinique et Thérapie Cellulaire, CHU de Limoges, Limoges, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Moreau
authors.affiliation: Hospitalisation à Domicile (HAD), CHU de Limoges, Limoges, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Vergnenègre
authors.affiliation: Service d'Oncologie et Radiothérapie, Centre Hospitalier, Brive-la-Gaillarde, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lefort
authors.affiliation: HAD Relai Santé Oncorese, Brive-la-Gaillarde, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Brillat
authors.affiliation: Réseau HEMATOLIM, CHU de Limoges, Limoges, France.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Jeannet
authors.affiliation: Pharmacie Centrale, CHU de Limoges, Limoges, France.
authors.forename: Aline
authors.initials: A
authors.lastname: Lagarde
authors.affiliation: Pharmacie Centrale, Centre Hospitalier, Brive-la-Gaillarde, France.
authors.forename: Annick
authors.initials: A
authors.lastname: Daulange
authors.affiliation: Service d'Hématologie Clinique et Thérapie Cellulaire, CHU de Limoges, Limoges, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Jaccard
authors.affiliation: Service d'Information Médicale et d'Evaluation (SIME), CHU de Limoges, Limoges, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Vergnenègre
authors.affiliation: Service d'Hématologie Clinique et Thérapie Cellulaire, CHU de Limoges, Limoges, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Bordessoule
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000069286:Bortezomib / Q000008:administration & dosage / Q000627:therapeutic use*; D017046:Cost Savings / Q000379:methods*; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006699:Home Care Services; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000188:drug therapy / Q000191:economics*; D010045:Outpatients; D011788:Quality of Life
chemical_list: D000970:Antineoplastic Agents; D000069286:Bortezomib
keywords: Bortezomib; Care network; Chemotherapy at home; Cost analysis; Hospital care at home; Multiple myeloma; Outpatient department; Outpatient unit; Patient satisfaction