-Author name in bold denotes the presenting author
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Clinically Relevant Abstract denotes an abstract that is clinically relevant.

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4776 Subcutaneous Versus Intravenous Rituximab in Non-Hodgkin Lymphoma Treated with R-CHOP: Economic Modeling for the USClinically Relevant Abstract

Program: Oral and Poster Abstracts
Session: 902. Health Services Research—Malignant Diseases: Poster III
Hematology Disease Topics & Pathways:
Biological, antibodies, Therapies
Monday, December 3, 2018, 6:00 PM-8:00 PM
Hall GH (San Diego Convention Center)

Ali McBride, PharmD, MS1,2,3, Sanjeev Balu, PhD4*, Kim Campbell, PharmD4*, Karen MacDonald, PhD5* and Ivo Abraham, PhD, RN5,6,7,8

1Division of Hematology/Oncology, Department of Pharmacy, The University of Arizona Cancer Center, Tucson, AZ
2Department of Pharmacy Practice and Science, The University of Arizona College of Pharmacy, Tucson, AZ
3Banner University Medical Center, Tucson, AZ
4Sandoz, Princeton, NJ
5Matrix45, Tucson, AZ
6University of Arizona Cancer Center, Tucson, AZ
7Center for Health Outcomes and PharmacoEconomic Research, Department of Pharmacy, The University of Arizona Cancer Center, Tucson, AZ
8Colleges of Pharmacy and Medicine, University of Arizona, Tucson, AZ

Introduction: The rituximab (RITUX) component of the R-CHOP regimen for non-Hodgkin lymphoma (NHL) consists of an intravenous (IV) initiation administration in cycle 1 followed in subsequent cycles by either: IV standard infusion (IV-S) or 90-minute (min) rapid-infusion (IV-R90), or subcutaneous (SC) administration in eligible patients. IV may be with reference rituximab (ref-RITUX) or a proposed biosimilar rituximab (biosim-RITUX). SC RITUX may offer time and cost savings; biosim-RITUX offers another potential cost-saving option. We performed a time-and-cost simulation of SC RITUX, ref-RITUX and biosim-RITUX from the US payer perspective.

Methods: Simulation analysis for one NHL patient over six cycles of R-CHOP using: [1] label-recommended administration times for all R-CHOP agents, [2] SC RITUX and ref-RITUX 1Q2018 average sales price (ASP, US$), and [3] 2018 reimbursement per Current Procedural Terminology codes (US$). Costs for the proposed biosim-RITUX were extrapolated at 1% decrements of ref-RITUX ASP from 15%-35%. IV simulations were replicated for 3 BSA-adjusted doses: small (1.6m2), average (1.85m2) and large (2.1m2) patients.

Results: Following cycle 1 IV RITUX, switching to SC saves 650 min over subsequent cycles 2-6 (or 2h10 min/cycle) compared to IV-S with ref-RITUX or biosim-RITUX at BSA=1.6m2, 720 min (2h24 min/cycle) at BSA=1.85m2, and 791 min (2h38 min/cycle) at BSA=2.1m2; time-savings with SC is 425min over subsequent cycles 2-6 (1h25 min/cycle) compared to IV-R90 with ref-RITUX or biosim-RITUX across all BSA.

Costs of 6 cycles of R-CHOP if switched to SC RITUX in cycles 2-6 were $54 higher compared to ref-RITUX IV-R90 but $104 lower versus ref-RITUX IV-S at BSA=1.6m2; at BSA=1.85m2, costs for SC were $3,854 and $4,012 lower than ref-RITUX, respectively; at BSA=2.1m2, SC saved $7,762 and $7,920 over ref-RITUX, respectively.

Compared to biosim-RITUX, costs for R-CHOP treatment with SC RITUX were higher at all decrements of biosimilar discounts at BSA=1.6m2for both IV-S (range: $3,647 to $8,649) and IV-R90 (range: $3,805 to $8,807); similarly, SC RITUX costs were higher than biosim-RITUX at all decrements of biosimilar discounts at BSA=1.85m2 for both IV-S (range: $325 to $6,109) and IVR-90 (range: $484 to $6,267). At BSA=2.1m2, SC RITUX costs were higher than biosim-RITUX IV-S at discounts ≥25% (from $286 @25% to $3,569 @35%) and higher than biosim-RITUX IV-R90 at discounts ≥24% (from $116 @24% to $3,727 @35%).

Conclusions: SC RITUX for R-CHOP therapy in NHL saves time compared to ref-RITUX and biosim-RITUX via IV-S or IV-R90. Compared to ref-RITUX IV-S and ref-RITUX IV-R90, SC RITUX saves costs except compared to IV-R90 in the smallest patient (BSA=1.6m2). Costs for SC RITUX were higher than biosim-RITUX IV-S and biosim-RITUX IV-R90 in both a small and an average-sized patient at all levels of biosimilar discount. In a large patient (BSA=2.1m2), biosim-RITUX saved cost versus SC RITUX if discounted at 25% for IV-S and 24% for IV-R90.

Disclosures: Balu: Sandoz Inc.: Employment. Campbell: Sandoz Inc.: Employment. MacDonald: Sandoz: Consultancy. Abraham: Sandoz: Consultancy.

*signifies non-member of ASH