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Intravenous versus subcutaneous trastuzumab: an economic and patient perspective

23 May 2019
Service Development
02 May 2019
Volume 28 · Issue 10

Abstract

Since 2005, when the first patients outside of a clinical trial were treated with trastuzumab at The Christie NHS Foundation Trust, a nurse-led service has been developed to facilitate and support a safe treatment pathway for patients. There have been significant developments in the number of patients treated, the mode of administration of the drug and patient choice regarding the location of treatment delivery. This article focuses on the change from intravenous to subcutaneous administration, considering patient experience and choice, particularly in light of the advent of biosimilar drugs, which will necessitate a return to the intravenous route. The relative costs of intravenous and subcutaneous administration are illustrated and the results of a patient survey presented, indicating a strong preference for subcutaneous trastuzumab.

The Christie NHS Foundation Trust is the largest single-site cancer centre in Europe, treating more than 44 000 patients a year. The first UK centre to be officially accredited as a comprehensive cancer centre, it serves a population of 3.2 million across Greater Manchester and Cheshire. In 2017, 66 447 systemic anticancer chemotherapy agents were administered in the UK's largest chemotherapy unit, across 14 other sites, a mobile chemotherapy unit and in patients' homes. Since 2005, when the first patients outside of a clinical trial were treated with trastuzumab (Herceptin), a nurse-led service has been developed to facilitate a supported and safe treatment pathway for patients. There has been a substantial rise in the number of patients treated with trastuzumab over the last 10 years (Figure 1) with additional developments in line with the Five Year Forward View vision for patient choice in relation to treatment venue and the overall goal of treatment administration closer to home (NHS England, 2014).

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Breast cancer
Trastuzumab
Chemotherapy
Patient preference
Survey