Advantages of Rapid Rituximab Administration in Oncology. Study and Analysis in Real Clinical Settings in Poland - Hospital Based HTA Project

Objective: Rituximab, a chimeric monoclonal antibody targeting CD20 on B lymphocytes, has revolutionized hematologic malignancy treatment since its FDA and EMA approvals in 1997 and 1998. For a long time, rituximab treatment has been the standard for follicular lymphoma (FL), diffuse large B-cell lymphoma, and chronic lymphocytic leukemia (CLL), significantly improving survival rates and quality of life. Rapid intravenous infusions, approved by the FDA in 2012 and EMA in 2023, reduce infusion times to 90 minutes, offering similar safety profiles to standard infusions with significant cost savings and reduced strain on healthcare resources. This analysis evaluates the benefits of rapid rituximab administration in Poland using Hospital-Based Health Technology Assessment (HB-HTA) methodology. Methods: Conducted from December 2023 to January 2024, the study involved 155 observations of standard infusions across 14 centers in Poland. Medical personnel completed forms detailing rituximab administration stages and patient information. Data were used to develop an economic model assessing the benefits of 90-minute infusions, replacing the observed standard delivery, considering setup time, medical personnel involvement, and hospital savings. Supplementary qualitative data were collected through 9 in-depth telephone interviews with medical personnel and patients. Results: The study included 155 patients with an average age of 61 years and an average infusion duration of 3 hours and 46 minutes. It is estimated that replacement of standard delivery with rapid infusions could save 21.47 PLN labor costs per infusion for CLL patients and 25.04 PLN for NHL patients, as well as would reduce bed occupancy and free up medical staff time. This is expected to allow the increased number of infusions to be performed monthly and allow for resource reallocation. Nurses expressed positive opinions on the benefits of rapid infusions, highlighting, among other things, reduced patient wait times and improved operational efficiency in ward operations Conclusions: Rapid rituximab infusions potentially would enhance patient convenience, healthcare resource efficacy, and reduce costs in the Polish healthcare sector setting. They also could improve patient quality of life by minimizing time in medical facilities. The adoption of rapid administration protocols can transform oncology practice, making it more efficient and patient-oriented. To fully realize these benefits, modifications to the NHF catalogue and public procurement criteria are recommended, along with developing outpatient care to reduce administrative burdens and relieve hospital resources. Abbreviations: CHP - cyclophosphamide, doxorubicin, and prednisone regimen; CLL - chronic lymphocytic leukemia; EMA - European Medicines Agency; FDA - US Food and Drug Administration; FL - follicular lymphoma; FTE - full-time equivalent; HB-HTA - Hospital-Based Health Technology Assessment; IRRs - Infusion-related reactions; NHF - National Health Fund; NHL - non-Hodgkin lymphoma.