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"A case for biologics (infusion vs subcutaneous) must be made on accurate real-world economic analysis" Heald et al (2021).
Comparing cost of IV and subcutaneous biologics


Objectives: One important group of people at higher risk from the SARS-CoV-2(COVID-19) pandemic are those with autoimmune conditions including rheumatoid arthritis/inflammatory bowel disease. To minimise infection risk, many people have been switched from intravenous to subcutaneous biologics including biosimilars.

Design: The survey was designed to understand comparative economic issues related to the intravenous infusion vs subcutaneous biologic administration routes for infliximab. The survey focused on direct cost drivers/indirect cost drivers. Acquisition costs of medicines were not included due to data not being available publicly. Wider policy implications linked to the pandemic were also explored.

Setting/participants: Semi structured single telephone interviews were carried out with twenty key stakeholders across the National Health Service(NHS) from 35clinical/42pharmacy/28commissioning roles. The interviews were undertaken virtually during April 2020 From interview(n=20) results a simple cost analysis was developed plus a qualitative analysis of reports on wider policy/patient impacts.

Results: Key findings included evidence of significant variation in local infusion tariffs UK wide, with interviewees reporting that not all actual costs incurred are captured in published tariff costs. A cost analysis showed administration costs 50% lower in the subcutaneous compared to infusion routes, with most patients administering subcutaneous medicines themselves. Other indirect benefits to this route included less pressure on infusion unit waiting times/reduced risk of COVID-19 infection plus reduced patient ‘out of pocket’ costs. However, this was to some extent offset by increased pressure on home-care and community/primary care services.

Conclusions: Switching from infusion to subcutaneous routes is currently driven by the COVID-19 pandemic in many services. A case for biologics (infusion vs subcutaneous) must be made on accurate real-world economic analysis. In an analysis of direct/indirect costs, excluding medicine acquisition costs, subcutaneous administration appears to be the more cost saving option for many patients even without the benefit of industry funded home-care.


Heald A, Bramham-Jones S, Davies M. Comparing cost of intravenous infusion and subcutaneous biologics in COVID-19 pandemic care pathways for Rheumatoid Arthritis and Inflammatory Bowel Disease – A brief UK stakeholder survey. Int J Clin Pract. 2021 May 8:e14341. doi: 10.1111/ijcp.14341. Epub ahead of print. PMID: 33963659.