A cost analysis study of the implementation of fixed-dosing of monoclonal antibodies in the Netherlands Cancer Institute
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RESEARCH ARTICLE
A cost analysis study of the implementation of fixed‑dosing of monoclonal antibodies in the Netherlands Cancer Institute Kimberley M. Heinhuis1,2 · Hannerieke J. Barkman3 · Jos H. Beijnen3,4 · Jeroen J. M. A. Hendrikx3,5 Received: 27 May 2020 / Accepted: 18 August 2020 © Springer Nature Switzerland AG 2020
Abstract Background There is a strong rationale for fixed-dosing of monoclonal antibodies in oncology. Although fixed-dosing of recently introduced monoclonal antibodies is well accepted, the rationale is also applicable for other monoclonal antibodies that already have been used for years, but are still body-size-based dosed in many hospitals. In the Netherlands Cancer Institute, Antoni van Leeuwenhoek (NKI-AVL), fixed-dosing has been implemented now for all monoclonal antibodies and, therefore, this site offers an ideal opportunity for a cost analysis study. Objective To investigate the financial impact of switching to fixed-dosing in the NKI-AVL. Setting The NKI-AVL. Method Information on the preparations of monoclonal antibodies was collected from August 2017 to February 2020. We compared the number of vials needed during preparation for fixed-dosing and body-size -based dosing strategies. The economic impact was calculated for 2 scenarios: scenario 1 assumed clustering of all preparations per day and scenario 2 assumed no clustering of preparations. Main outcome measure Number of saved vials and the correlating savings in health care costs. Results The implementation of fixed-dosing resulted in a substantial reduction in vials used for almost all monoclonal antibodies. The economic savings were calculated to be €0,8 and €3,1 million per year for scenario 1 and 2, respectively. Conclusion Fixed-dosing resulted in substantial savings in health care costs. Keywords Cancer · Cost analysis · Fixed-dosing · Monoclonal antibodies · Oncology
Impacts on practice • The implementation of fixed-dosing would result in
increased safety and reduced spillage of vials.
• The implementation of fixed-dosing of all monoclonal
antibodies would result in savings in health care costs.
* Kimberley M. Heinhuis [email protected] 1
Department of Clinical Pharmacology, The Netherlands Cancer Institute, Plesmanlaan 121, PO Box 90203, 1066 CX Amsterdam, The Netherlands
2
Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
3
Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
4
Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
5
Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
Introduction In the last years, there is increasing interest in fixed-dosing of monoclonal antibodies instead of body-size-based dosing (e.g. in mg/kg or mg/m2). Based on the pharmacokinetics and pharmacodynamics of monoclonal antibodies there is a strong rationale that the influence of body size on therapeutic outcome is limited [1]. Once the target of monoc
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