Abstract Background/Aims Infusion units are pivotal in delivering complex therapies including intravenous immunoglobulin (IVIg), biologic agents and bone-protection treatments. Increasing demand, alongside limited physical capacity, often constrains timely patient access and contributes to service bottlenecks. Furthermore, the high cost of many infused therapies necessitates a continuous focus on efficiency. The aim of this evaluation was to identify opportunities to enhance capacity and improve cost-effectiveness in a tertiary centre infusion unit by assessing treatment duration and potential drug cost modifications without compromising clinical outcomes. Methods We performed a retrospective evaluation of all patients attending the infusion unit receiving IVIg, rituximab, and intravenous zoledronate between September 2024 and September 2025. For IVIg, the mean number of infusions per treatment cycle was calculated and compared against a proposed two-infusions-per-cycle protocol. For rituximab, infusion duration (in hours) was assessed against evidence-based two-hour infusion protocols. For zoledronate, cost modelling compared 5 mg dosing with the use of 4 mg dosing — considered clinically equivalent in efficacy — to estimate potential savings. Key outcomes were the potential number of infusion slots created by reducing IVIg course length and the number of hours saved through shortened rituximab infusions, in addition to the annual cost reduction achieved by amending zoledronate dosing. Results Over the one-year period, 168 IVIg cycles, 1,040 rituximab infusions, and 253 zoledronate infusions were administered. The mean number of IVIg infusions per treatment cycle was 2.6, with potential to safely reduce to a protocol of two infusions per treatment cycle, thereby creating approximately 97 infusion slots per year. Rituximab infusions totalled 6,240 hours, but implementation of a two-hour infusion protocol could lead to a 67% reduction of the total number of hours, with potential to create up to 2,080 additional infusion slots. Regarding zoledronate, local practice involves using two vials of 4mg to draw up a 5mg dosage, rather than using more costly individual 5mg vials. Therefore, switching zoledronate from a 5 mg to a 4 mg dosage could yield an annual cost saving of £1,518 when modelled against using 2x 4mg vials, whilst the cost saving compared with 5mg vials would be between £15,939 and £57,684, depending upon brand. Together, these changes could translate to a significant increase in infusion capacity and a measurable reduction in drug expenditure. Conclusion This real-world tertiary service evaluation demonstrates that targeted evidence-based adjustments in treatment delivery and drug selection can meaningfully increase infusion unit capacity and reduce costs. Streamlining IVIg course duration, adopting faster infusion protocols for rituximab, and optimising zoledronate dosing represent implementable interventions with tangible benefits. These findings highlight the value of continuous service review to ensure infusion units can meet rising demand efficiently and safely, in an increasingly under-pressure NHS healthcare setting, without compromising patient care. Disclosure M. Saini: None. K. Shetty: None. N. Gioffre: None. H. Gebreyohanes: None. T. Malley: None.
Saini et al. (Wed,) studied this question.