Economic and organizational impact of oral versus intravenous and subcutaneous administration of hypomethylating agents in patients with acute myeloid leukemia not eligible for intensive chemotherapy in Spain
- 1IQVIA, Barcelona, Spain
- 2Otsuka, Barcelona, Spain
Abstract
Acute myeloid leukemia (AML) primarily affects older adults, many of whom are unsuitable for intensive chemotherapy. Hypomethylating agents (HMA) -intravenous (IV) decitabine and subcutaneous (SC) azacitidine- are standard therapeutic options but require frequent hospital visits and substantial healthcare resource use. Oral decitabine/cedazuridine (DEC-C) offers a therapeutically equivalent alternative that may reduce hospital resource burden and improve patient convenience. This study estimated and compared the economic and organizational impact of IV, SC, and oral HMA administration in AML patients unfit for standard intensive chemotherapy, from the perspective of the Spanish National Health System. A micro‑costing model quantified direct non‑pharmacological costs associated solely with the administration route across five domains: drug preparation and administration, treatment‑related hospitalizations, medical transportation, catheter management, and infections. Resource use was derived from a survey of 30 healthcare professionals across 16 hospitals and valued using official tariffs. Costs were calculated separately for induction and subsequent cycles; drug acquisition costs were excluded. Non‑pharmacological costs per patient were €9,998 for IV decitabine, €12,177 for SC azacitidine, and €1,306 for oral DEC‑C, representing cost reductions of 87% and 89% for oral therapy versus IV and SC, respectively. Savings were driven mainly by reductions in hospitalization (58–61%), transport (13–22%), infections (9%–12%), administration‑related activities (11–12%) and the avoidance of catheter-related costs. Oral therapy also markedly reduced resource utilization, including 40–50 fewer hours of healthcare professional time, 8–9 fewer inpatient days, and 4–8 fewer ambulance transfers per patient. Catheter use decreased by 33%, and infection risk declined by 87% versus IV and 54% versus SC. Oral administration substantially reduces direct non‑drug costs and frees hospital capacity, offering meaningful organizational efficiencies and contributing to the sustainability of AML care within a resource‑constrained health system. These findings reinforce the value of integrating oral HMAs into clinical pathways.
Related
- Inflammatory Bowel Disease Patients’ Acceptance for Switching from Intravenous Infliximab or Vedolizumab to Subcutaneous Formulation: The Nancy Experience
- A Wireless Wearable Platform for Intravenous Drug Self-Administration in Freely Behaving Rats
- Intrathecal Transplantation of Human Umbilical Cord‐Derived MSCs Outperforms Intravenous Administration in Attenuating Pathology and Cognitive Deficits in Alzheimer's Disease Mice
- Negative Affective States Are Not Detected in Rats Following an Intravenous Self-Administration Regimen Leading to Incubation of Oxycodone Craving.
- Determinants of uptake of praziquantel, chemotherapy for schistosomiasis treatment during mass drug administration in Busia County, Kenya.
BibTeX
@article{avella2026economic,
title = {{Economic and organizational impact of oral versus intravenous and subcutaneous administration of hypomethylating agents in patients with acute myeloid leukemia not eligible for intensive chemotherapy in Spain}},
author = {María Lloret Avellá and Mafalda Carmo and Núria Paladio Duran and Pere Blancher Parcerisa},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358426},
url = {https://doi.org/10.1371/journal.pone.0358426},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Economic and organizational impact of oral versus intravenous and subcutaneous administration of hypomethylating agents in patients with acute myeloid leukemia not eligible for intensive chemotherapy in Spain
AU - María Lloret Avellá
AU - Mafalda Carmo
AU - Núria Paladio Duran
AU - Pere Blancher Parcerisa
PY - 2026
DA - 2026/09/22
JO - PLOS One
DO - 10.1371/journal.pone.0358426
UR - https://doi.org/10.1371/journal.pone.0358426
AB - Acute myeloid leukemia (AML) primarily affects older adults, many of whom are unsuitable for intensive chemotherapy. Hypomethylating agents (HMA) -intravenous (IV) decitabine and subcutaneous (SC) azacitidine- are standard therapeutic options but require frequent hospital visits and substantial healthcare resource use. Oral decitabine/cedazuridine (DEC-C) offers a therapeutically equivalent alternative that may reduce hospital resource burden and improve patient convenience. This study estimated and compared the economic and organizational impact of IV, SC, and oral HMA administration in AML patients unfit for standard intensive chemotherapy, from the perspective of the Spanish National Health System. A micro‑costing model quantified direct non‑pharmacological costs associated solely with the administration route across five domains: drug preparation and administration, treatment‑related hospitalizations, medical transportation, catheter management, and infections. Resource use was derived from a survey of 30 healthcare professionals across 16 hospitals and valued using official tariffs. Costs were calculated separately for induction and subsequent cycles; drug acquisition costs were excluded. Non‑pharmacological costs per patient were €9,998 for IV decitabine, €12,177 for SC azacitidine, and €1,306 for oral DEC‑C, representing cost reductions of 87% and 89% for oral therapy versus IV and SC, respectively. Savings were driven mainly by reductions in hospitalization (58–61%), transport (13–22%), infections (9%–12%), administration‑related activities (11–12%) and the avoidance of catheter-related costs. Oral therapy also markedly reduced resource utilization, including 40–50 fewer hours of healthcare professional time, 8–9 fewer inpatient days, and 4–8 fewer ambulance transfers per patient. Catheter use decreased by 33%, and infection risk declined by 87% versus IV and 54% versus SC. Oral administration substantially reduces direct non‑drug costs and frees hospital capacity, offering meaningful organizational efficiencies and contributing to the sustainability of AML care within a resource‑constrained health system. These findings reinforce the value of integrating oral HMAs into clinical pathways.
SN - 1932-6203
ER -