Home-Based Trastuzumab Self-Administration Reduces Costs and Time Burden

Home-based self-administration of subcutaneous (SC) trastuzumab (Herceptin) may help alleviate resource constraints in oncology care by reducing the time and costs associated with treatment administration, according to findings published in JCO Oncology Practice.¹

The study evaluated resource utilization, administration costs, and patient preferences associated with home-based self-administration compared with hospital-based administration in oncology daycare units. The findings suggest that moving appropriate treatment administration outside the hospital could reduce demands on both patients and health care professionals (HCPs), while potentially freeing clinic capacity for other patients.

Investigators found that home-based self-administration reduced patient time by 74.3 minutes (86.9%) and HCP time by 29.9 minutes (87.4%) per administration. Administration costs, excluding drug costs, were €35.72 per administration with home-based self-administration compared with €61.61 with hospital-based administration, representing a 42% reduction.

Societal costs were also lower with home-based administration, at €24.86 compared with €39.37 per administration. This represented a 37% reduction and a savings of €14.51 per administration.

Study Evaluates Resource Use and Costs of Home-Based Administration

The cross-sectional, noninterventional study used a microcosting approach to evaluate the resources and costs associated with SC trastuzumab administration from a societal perspective. Patients receiving home-based self-administration were recruited from SpaarneGasthuis in Hoofddorp, the Netherlands. Data for hospital-based administration were obtained from previously published research rather than from a concurrently enrolled comparison group.¹

Investigators assessed the time required for treatment administration, HCP involvement, patient and societal costs, and patient preferences. The analysis considered the resources associated with delivering treatment in each setting, allowing investigators to evaluate differences beyond the direct costs of administration.

The distinction between administration costs and societal costs is relevant to interpreting the findings. Although administration costs capture expenses associated with delivering treatment, the societal perspective also considers costs extending beyond the health care facility. The lower estimates in both categories suggest that the potential economic benefits of home-based self-administration may extend beyond reducing hospital resource use.

Patient Preferences and Nationwide Cost-Saving Potential

Patient preferences also favored home-based administration. Among the 25 patients who completed the preference questionnaire, 23 (92%) indicated a preference for self-administration at home over receiving treatment in a hospital setting. Although the questionnaire included a relatively small number of patients, the finding provides additional insight into the potential acceptability of this approach.

To assess the potential impact of broader implementation, investigators modeled a hypothetical nationwide scenario in the Netherlands in which 90% of eligible patients adopted home-based self-administration. Under this scenario, the approach was estimated to save 21,323 hours of patient chair time and reduce HCP time requirements by the equivalent of 12 full-time equivalents.

The nationwide model also projected savings of €1,510,656 in administration costs and €543,815 in societal costs. These estimates illustrate how reductions observed at the individual administration level could translate into broader resource savings if home-based self-administration were widely adopted.

Implications for Oncology Care Delivery

Previous discussions of home-based HER2-targeted therapy have highlighted the potential to reduce treatment-related demands on patients and oncology clinics. In an interview with Targeted Onc^TM, Sara M. Tolaney, MD, MPH, discussed the advantages of subcutaneous trastuzumab and pertuzumab (Perjeta), including shorter administration times and reduced demands on infusion-center resources. She also described an investigational approach involving home administration by visiting nurses, noting that eliminating the need for patients to travel to infusion centers could provide additional convenience, particularly for those receiving ongoing maintenance treatment. The current findings extend this discussion by evaluating patient self-administration at home and quantifying its potential effects on patient time, HCP workload, and administration costs.²

The findings suggest that home-based self-administration of SC trastuzumab could help reduce demands on oncology daycare units and health care personnel while preserving clinic capacity for patients requiring in-person care. Reducing the time patients spend traveling to and receiving treatment in a hospital setting may also lessen the logistical burden associated with repeated administrations.

However, the study's cross-sectional, noninterventional design and reliance on previously published data for hospital-based administration should be considered when interpreting the findings. Because the 2 groups were not enrolled and evaluated concurrently, differences between the study populations or data collection methods may have influenced the comparisons. Additionally, the nationwide estimates represent a hypothetical implementation scenario in the Netherlands and may not directly translate to other health care systems.

Further evaluation across different care settings could help clarify the broader applicability of these findings and the potential role of home-based self-administration in oncology treatment delivery.

REFERENCES

1. Zietse M, Raijmaakers JRD, Beeker A, et al. Optimizing cancer care delivery: capacity and cost benefits of home-based self-administration of subcutaneous trastuzumab. JCO Oncol Pract. Published online November 3, 2026. doi:10.1200/OP-26-00660.

2. Case 1: Subcutaneous HP FDC formulation in early-stage HER2+ BC. Targeted Onc. June 1, 2022. https://tinyurl.com/24t82zcx