Subkutan vs intravenös immunterapi – värdet för lungcancervården i Sverige

With an estimated global incidence of 2.2 million cases in 2020, lung cancer is the second most common cancer worldwide after breast cancer. In Sweden, approximately 3,500 people died from lung cancer in 2021, and the relative five-year survival rate was 24% for men and 32% for women. Although overall survival remains low, it has improved over recent decades as a result of advances in medical treatment. Novel therapies, including targeted treatments and immunotherapies, have reshaped the lung cancer treatment landscape and are now routinely used in most EU countries. Immunotherapies, harness the body’s immune system to target tumour cells and can result in improved survival and durable clinical benefit. Traditionally, immunotherapy has been administrated intravenously, a process that involves multiple preparation steps in both pharmacy and hospital settings, followed by lengthy infusion times. This mode of administration is resource-intensive, requiring substantial time from both pharmacy and clinical staff, while also occupying treatment chairs and equipment. Previous studies have shown that intravenous administration may require up to 90 minutes staff time and up to three hours of chair time per patient visit. More recently, subcutaneous formulations of immunotherapies have been introduced as an alternative. Subcutaneous administration is a simpler and faster process and has been shown to provide comparable clinical efficacy. The aim of this study was to compare resource use associated with subcutaneous and intravenous administration of immunotherapy in lung cancer, focusing on reductions in administration time, chair time, and potential cost savings following a transition to subcutaneous treatment. Differences in resource use were estimated trough an analysis of total capacity at three Swedish lung clinics. The analysis included time spent by pharmacy staff and healthcare personnel, as well as the use of physical resources such as treatment chairs and equipment. The time-driven activity-based costing (TDABC) method was applied to map processes and measure resource utilization. As a basis for the analysis, a targeted literature review was conducted to identify relevant process steps and develop process maps. These were validated through interviews and workshops with staff at each clinic. Based on the validated process maps, resource use and differences between subcutaneous and intravenous administration were and subsequently applied to the clinics’ annual patient flows. The results showed that the total estimated savings associated with a transition to subcutaneous treatment amounted to SEK 4.3 million per year. Subcutaneous administration was more efficient per process, per patient, and per year for the included clinics. The differences observed between clinics reflect variations in capacity and workload within the Swedish healthcare system. The study’s findings indicate that subcutaneous treatment can reduce capacity strain on lung cancer clinics through shorter nursing time, reduced chair time, and a decreased need for drug preparation. The identified efficiency gains associated with subcutaneous monotherapy in lung cancer care highlight the potential to better meet future healthcare demands.