Decision tree model to assess consequences and costs associated with therapy administration pathways for patients with HER2+ breast cancer in Italian oncological centers

BACKGROUND AND AIMS: Human Epidermal Growth Factor Receptor 2-positive (HER2+) breast cancer poses significant therapeutic challenges, particularly concerning treatment administration pathways and their associated costs. This study evaluates the managerial and economic impacts of different therapeutic administration scenarios for HER2-positive breast cancer patients, focusing on optimizing hospital workflows, resource utilization, and patient outcomes in Italian oncological centers. METHODS: A decision tree model was developed to simulate and compare five treatment administration pathways: Standard, Drug-Change, Drug Day, Dedicated Ambulatory, and Optimal Pathway scenarios. The model integrates patient and healthcare professional (HCP) activity and waiting times, infusion chair occupation, and direct and indirect costs. Sensitivity analyses assessed variability in model outcomes. RESULTS: Switching from endovenous (EV) to subcutaneous (SC) administration substantially reduced patient throughput times and HCP workloads. The Optimal Pathway scenario yielded the highest resource optimisation, reducing HCP activity time by up to 48 hours, infusional chair occupational time by up to 150 hours, and patients' total time by up to 753 hours per 100 patients monthly. Cost analyses indicated significant savings in both direct and indirect cost for all the proposed scenarios in comparison to the Standard one. CONCLUSION: The adoption of SC formulations and innovative pathway optimizations enhances treatment organizational efficiency and reduces both direct and indirect costs. These findings underscore the value of tailored approaches to administration based on the structural and organizational characteristics of individual oncology centers, aligning with current Italian healthcare reforms.