Hospital financial implications of subcutaneous versus intravenous trastuzumab plus pertuzumab in Japan: a micro-costing and threshold analysis
This study demonstrates that in Japan, switching trastuzumab plus pertuzumab from intravenous to subcutaneous administration improves hospital financial outcomes by significantly reducing material and labor costs, which outweighs the lower outpatient management fee revenue.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the treatment of a specific type of breast cancer, doctors often use a powerful combination of two medicines to stop the disease from returning or spreading. These medicines, known as trastuzumab and pertuzumab, work by targeting a protein on the surface of cancer cells. For years, the standard way to give these drugs has been through an intravenous line, a tube that goes into a vein, allowing the medicine to flow slowly into the bloodstream over a period of time. However, a newer method has been developed that delivers the same medicines through a quick injection just under the skin. While this subcutaneous method is faster and preferred by many patients, it has created a financial puzzle for hospitals in Japan. The government system that pays for medical care reimburses hospitals significantly less money for the quick skin injection than it does for the longer vein infusion. This difference in payment has led many hospital administrators to worry that switching to the faster, more convenient method would actually cost them money, potentially discouraging them from adopting a treatment that is better for patients.
Researchers at Gifu Prefectural General Medical Center set out to solve this puzzle by looking closely at the actual costs and time involved in both methods. They did not just look at the payment the hospital receives; they calculated the real expenses the hospital incurs every time a patient comes in. This included the cost of the physical supplies, such as needles, tubes, and fluids, as well as the cost of the nurses' time. The team gathered data from hundreds of patient visits to measure exactly how long a patient spent in the clinic from the moment they arrived until they left. They then built a detailed model of a standard one-year treatment course, which involves seventeen separate visits, to see how the numbers played out over the long term.
The study found that while the hospital receives less money for the subcutaneous injection, the savings in time and supplies are so large that the hospital actually ends up with more money in its pocket. When a patient receives the injection under the skin, the hospital spends far less on materials because it does not need the complex tubing and fluids required for the vein infusion. More importantly, the visit takes significantly less time. The researchers measured that a patient receiving the skin injection spent about 183 minutes in the clinic, compared to 285 minutes for the vein infusion. Because the visit is shorter, nurses can attend to patients more quickly, freeing up their time and the clinic's chairs for other work. When the researchers added up the savings from the cheaper supplies and the reduced nursing time, these savings were much larger than the difference in the government payment. In fact, for a single patient treated over a full year, switching to the skin injection improved the hospital's financial balance by more than 51,000 yen in the 2025 payment schedule.
The researchers tested their findings to see if they held true under different conditions, such as if a hospital paid its nurses a different wage or if the treatment took a different number of visits. They ran thousands of computer simulations to account for these variations. In every single scenario they tested, the subcutaneous method remained the better financial choice for the hospital. Even in the worst-case scenarios where the time saved was smaller or wages were higher, the skin injection still resulted in a net gain. The study also looked at situations where patients receive this treatment alongside other cancer drugs given through a vein. Even in these mixed treatments, the time saved by using the skin injection for the targeted drugs still provided a financial advantage. The researchers concluded that the fear of losing money by switching to the faster method is unfounded. The efficiency gained from shorter visits and fewer supplies outweighs the lower government payment, meaning hospitals can afford to adopt the patient-friendly method without hurting their finances.
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