Optimizing Cancer Care Delivery: Capacity and Cost Benefits of Home-Based Self-Administration of Subcutaneous Trastuzumab

Purpose Self-administration of subcutaneous (SC) monoclonal antibodies offers a potential strategy to mitigate capacity constraints and nurse shortages in oncology care. This study aimed to evaluate the costs and resource use associated with SC trastuzumab administration in oncology daycare units and home-based self-administration from a societal perspective. Materials and Methods We conducted a cross-sectional, noninterventional study using a microcosting approach. Patients receiving home-based self-administration were recruited from the Spaarne Gasthuis, Hoofddorp, the Netherlands, whereas hospital-based administration was based on previously published data. Data were collected on time spent on administration, health care professional (HCP) involvement, patient and societal costs, and patient preferences. Results Home-based self-administration reduced patient time by 74.3 minutes (86.9%) and HCP time by 29.9 minutes (87.4%) per administration. Administration costs (excluding drug costs) were €35.72 for self-administration versus €61.61 for hospital-based administration, a €25.89 reduction (–42%). Societal costs were €24.86 for self-administration and €39.37 for hospital-based, saving €14.51 (–37%). Of the 25 patients who completed the preference questionnaire, 23 (92%) preferred home-based self-administration. In a hypothetical nationwide scenario with 90% uptake of home-based self-administration in the Netherlands, this model could save 21,323 hours of patient chair time, reduce HCP time by 12 full-time equivalents, and save €1,510,656 in administration costs and €543,815 in societal costs. Conclusion Home-based self-administration of SC trastuzumab was associated with reduced time investments for HCPs and patients, and with lower administration and societal costs than hospital-based administration. These findings highlight the potential of home-based self-administration as an efficient model to alleviate the strain on oncology care.