Subcutaneous vs intravenous rituximab in patients with non-Hodgkin lymphoma: a time and motion study in the United Kingdom

J Med Econ. 2014 Jul;17(7):459-68. doi: 10.3111/13696998.2014.914033. Epub 2014 May 7.


Objective: Rituximab is part of standard therapy for many non-Hodgkin lymphoma (NHL) patients, and is usually administered as an intravenous (IV) infusion. A formulation for subcutaneous (SC) injection will be available from June 2014. A time and motion study was conducted to investigate the staff time and costs associated with administration of SC and IV rituximab.

Research design and methods: The time and motion study was conducted in three UK centers alongside a phase III trial of SC rituximab in patients with NHL ( identifier NCT01461928). Active healthcare professional (HCP) time spent on the preparation and administration of IV and SC rituximab was recorded and used to calculate the associated costs.

Results: Total active HCP time associated with administration of IV rituximab was 223.3 min (95% CI = 218.0-228.7), vs 48.5 min (95% CI = 45.5-51.6) for SC rituximab, a saving of 174.8 min (95% CI = 172.5-177.1) per session. Patient time in the treatment room was 263.8 min (95% CI = 236.6-294.3) for IV rituximab and 70.0 min (95% CI = 57.1-87.2) for SC rituximab, per session. The SC formulation reduced total mean staff costs by £115.17 (95% CI = 98.95-136.93) per session. Differing monitoring scenarios during infusion consistently showed time and cost savings for SC rituximab.

Limitations: Study limitations include the non-interventional design and lack of statistical power, and the investigational nature of SC rituximab. The data collected did not account for patient and center characteristics and variability on active HCP time.

Conclusions: SC rituximab was associated with reduced active HCP time and costs vs IV rituximab, as well as reduced patient time in the treatment room. Switching from IV to SC rituximab could increase treatment room capacity and patient throughput, as well as improving the patient experience.

Keywords: Cost; Intravenous infusion; Rituximab; Subcutaneous; Time and motion.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Intravenous / economics*
  • Antibodies, Monoclonal, Murine-Derived / administration & dosage*
  • Antibodies, Monoclonal, Murine-Derived / economics*
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Agents / economics
  • Antineoplastic Agents / therapeutic use
  • Clinical Trials, Phase III as Topic
  • Costs and Cost Analysis
  • Health Personnel / economics*
  • Humans
  • Injections, Subcutaneous / economics*
  • Lymphoma, Non-Hodgkin / drug therapy*
  • Lymphoma, Non-Hodgkin / economics
  • Outpatient Clinics, Hospital / economics
  • Prospective Studies
  • Rituximab
  • State Medicine / economics
  • Time and Motion Studies*
  • United Kingdom


  • Antibodies, Monoclonal, Murine-Derived
  • Antineoplastic Agents
  • Rituximab

Associated data