Evaluation of the economic benefits, administration times, and patient preferences associated with the use of biotechnological drugs administered subcutaneously and intravenously in patients with cancer: a systematic review

Cancer imposes a high economic burden with medical care and medication costs. We evaluate the costs, the use of resources, the administration time, and the patient preferences associated with the use of biotechnological drugs in SC and IV presentations. A systematic literature search was conducted in PubMed, Embase, and seven additional databases. The search was carried out in September 2021 and included only studies directly comparing SC and IV presentations. Evidence was synthesized narratively. 34 references were included, which only analyzed bortezomib, daratumumab, rituximab, and trastuzumab. Reduction in preparation costs of SC compared to IV presentations ranged from 6.6% to 50.1%, and in administration costs from 4.5% to 95.3%. SC administration of rituximab and trastuzumab resulted in less productivity loss. More than 68% of patients reported greater satisfaction with the SC route. A reduction of time in the infusion chair, lower costs of resources for preparation, and health personnel for the administration process were identified with SC administration. The use of SC daratumumab, rituximab, and trastuzumab in patients with cancer reduces direct and indirect costs and adverse events compared to IV use. Patients prefer the SC administration, perceiving more comfort, and less pain at the administration site.癌症在医疗护理与药物治疗方面带来了沉重的经济负担。本研究针对皮下注射（Subcutaneous, SC）与静脉注射（Intravenous, IV）剂型的生物技术药物，对其相关成本、资源消耗、给药时长及患者偏好展开评估。研究团队于2021年9月在PubMed、Embase及另外7个数据库开展系统性文献检索，仅纳入直接对比SC与IV剂型的相关研究，并采用叙述性综合法对证据进行整合。最终纳入34篇文献，所分析的药物仅涉及硼替佐米（bortezomib）、达雷妥尤单抗（daratumumab）、利妥昔单抗（rituximab）及曲妥珠单抗（trastuzumab）。与IV剂型相比，SC剂型的配药成本降低幅度为6.6%至50.1%，给药成本降低幅度则为4.5%至95.3%。利妥昔单抗与曲妥珠单抗的SC给药方式可减少误工损失。超68%的患者表示对SC给药途径更为满意。SC给药方式可缩短患者在输液椅上的停留时长，同时降低配药环节的资源消耗成本与给药过程中医护人员的人力成本。与IV给药相比，癌症患者使用SC剂型的达雷妥尤单抗、利妥昔单抗及曲妥珠单抗，可降低直接与间接成本，同时减少不良事件发生。患者更倾向于SC给药方式，因其感知到更高的舒适度与更低的给药部位疼痛。