Increasing Operational Capacity and Reducing Costs of Rituximab Administration: A Costing Analysis

Abstract

Objective. Originator intravenous rituximab is an important rheumatology treatment but is costly, and administration requires several hours. Because biosimilar rituximab may cost less and subcutaneous rituximab requires a shorter visit, both may reduce costs and increase treatment capacity (infusions per year).Methods. We implemented time-driven activity-based costing (TDABC), a method to assess costs and opportunities to increase capacity, throughout the care pathway for 26 patients receiving a total of 30 rituximab infusions. Using the TDABC estimates, we created a base case, which included provider time, salaries, infusion rates and times, and drug formulation, to simulate an induction cycle (two infusions). We varied these parameters in sensitivity analyses and assessed the impact of infusion rates and formulation (biosimilar vs. subcutaneous) on capacity before and after assuming a fixed budget.Results. The base-case cost was $19 452; more than 90% was due to drug cost. In sensitivity analyses, varying projected biosimilar cost led to the greatest cost savings ($8,988 per cycle). Faster infusion rates and subcutaneous rituximab increased annual capacity (300% and 800%, respectively). With a fixed budget, subcutaneous rituximab led to a relative increase in capacity over biosimilar rituximab except when biosimilar cost savings relative to originator rituximab exceeded 40%; faster biosimilar infusion rates did not meaningfully affect these findings.Conclusion. Using TDABC, we demonstrate that rituximab cost is the primary driver of treatment cost, but capacity is largely driven by treatment time. Subcutaneous rituximab leads to higher capacity than biosimilar rituximab across a range of plausible costs; its use in rheumatology should be studied.

ANCA-associated Vasculitis Management in the United States: Data From the Rheumatology Informatics System for Effectiveness (RISE) Registry

“…Similar studies conducted outside of the US would also be useful to provide perspective on how practice varies internationally, especially given the cost of RTX therapy. 11 In comparison with CYC use, we observed that MTX was more commonly used to treat AAV at various timepoints in the clinical course of this cohort. This may reflect that patients with AAV in RISE have less severe disease and/or that providers and patients prefer MTX over alternative options because of different side effect profiles or comfort level.…”

Health impact and cost of COVID-19 prophylaxis with monoclonal antibodies

“…23 We estimated the cost of services related to mAb PEP administration as $114 based on a time-driven activity-based cost estimate reported for outpatient subcutaneous administration of another medication adjusted to 2020 US$ (appendix page 3). 24…”

“…23 We estimated the cost of services related to mAb PEP administration as $114 based on a time-driven activity-based cost estimate reported for outpatient subcutaneous administration of another medication adjusted to 2020 US$ (appendix page 3). 24 Analytical methods: To estimate the cost and impact of PEP, we used an analytical model summarized by a decision tree (Figure 1) with a choice node for mAb PEP followed by chance nodes for symptomatic infection, hospitalization, and death. We used demographic data from confirmed cases of COVID-19 to identify households where PEP would be indicated, and then used demographic data on household structure to identify the age, sex, and race of the household members who could receive mAb PEP.…”

Contemporary management challenges in seropositive NMOSD

“…The cost of inebilizumab for the first year of treatment is approximately $393,000 USD for three infusions (two loading doses, followed by a single 300 mg dose 6 months later) and $262,000 USD per year, for two yearly doses [ 25 ]. In contrast, rituximab and biosimilars are relatively modestly priced: $19,452 USD for two 6-month infusions per year) [ 30 ].…”