OBJECTIVES: Subcutaneous (SC) formulations of daratumumab replace the previous need for intravenous infusion, potentially enabling treatment to be provided at alternative sites of care. This research aims to evaluate if daratumumab SC injection for multiple myeloma in the home care setting can provide value to patients and hospitals in terms of time spent on treatment and associated costs, versus receiving treatment in the Spanish hospital setting.

METHODS: A simulation tool was developed to model SC daratumumab treatment delivery, comparing scenarios where home treatment was available via a third-party provider versus all patients remain treated at hospital. Doses were modelled over a continuous timeframe using discrete event simulation. Patient characteristics were assigned probabilistically to determine eligibility for home treatment, and doses were scheduled according to product label for patients treated in combination with lenalidomide and dexamethasone. Inputs relating to hospital capacity, time for treatment, costs, and patient characteristics were gathered from a quantitative survey of treatment providers.

RESULTS: When simulations (10 repeats) were run using parameters for a typical Spanish hospital over a 5-year timeframe, 27 patients were treated and mean results showed that a total of 865 doses were administered. With the availability of a home treatment program, 234 doses were administered in the home setting instead of the hospital. This was associated with reduced costs to the hospital of €363 per patient, and considerable reductions in patient, caregiver and physician time dedicated to treatment (21.6, 14.1 and 2.2 hours per patient, respectively), while provider costs were €1,009 per patient. Additionally, 9.7 days of total chair-time became available for treating other patients at the hospital. Wider benefits, such as improved patient quality of life, could also be observed.

CONCLUSIONS: The results of this simulation have demonstrated the benefits to patients and hospitals of engaging in daratumumab home treatment programs.