\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{Comparing cost of intravenous infusion and subcutaneous biologics in
COVID-19 pandemic care pathways -- A brief UK stakeholder survey}



\author[1]{Adrian Heald}%
\author[2]{Steven Bramham-Jones}%
\author[3]{Mark Davies}%
\affil[1]{Salford Royal Hospitals NHS Trust}%
\affil[2]{Res Consortium}%
\affil[3]{Affiliation not available}%


\vspace{-1em}



  
  \date{May 21, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Objectives One important group of people at higher risk from the
COVID-19 pandemic are those with autoimmune conditions including
rheumatoid arthritis/inflammatory bowel disease. To minimise infection
risk, many people are now being switched from intravenous to
subcutaneous biologics including biosimilars. A key question is how
transition costs are viewed by clinicians. Design The survey was
designed to understand the 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. Wider policy implications linked to the pandemic were also
explored. Setting/Participants Semi structured telephone interviews were
carried out with twenty key stakeholders across the NHS from
clinical/pharmacy/commissioning roles. The interviews were undertaken
virtually 5thApril-27thApril 2020 and included a semi-structured
interview framework with questions across the two administration routes.
Results From interview results a simple cost analysis was developed plus
a qualitative analysis of reports on wider policy/patient impacts. Key
findings included evidence of significant variation in 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\% that of infusion, with a most patients
administering subcutaneous medicines themselves. Other indirect benefits
to this route included less pressure on infusion unit waiting times and
reduced risk of COVID-19 infection plus reduced patient 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 being 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.%
\end{abstract}%



\sloppy


\textbf{Hosted file}

\verb`CTHC.CostPaper_11 Feb 2021.docx`  available at \url{https://authorea.com/users/312300/articles/509807-comparing-cost-of-intravenous-infusion-and-subcutaneous-biologics-in-covid-19-pandemic-care-pathways-a-brief-uk-stakeholder-survey}

\textbf{Hosted file}

\verb`CTHC cost paper Tables.docx`  available at \url{https://authorea.com/users/312300/articles/509807-comparing-cost-of-intravenous-infusion-and-subcutaneous-biologics-in-covid-19-pandemic-care-pathways-a-brief-uk-stakeholder-survey}

\textbf{Hosted file}

\verb`Costs paper Fig 1.docx`  available at \url{https://authorea.com/users/312300/articles/509807-comparing-cost-of-intravenous-infusion-and-subcutaneous-biologics-in-covid-19-pandemic-care-pathways-a-brief-uk-stakeholder-survey}

\textbf{Hosted file}

\verb`Costs paper Figure 2.docx`  available at \url{https://authorea.com/users/312300/articles/509807-comparing-cost-of-intravenous-infusion-and-subcutaneous-biologics-in-covid-19-pandemic-care-pathways-a-brief-uk-stakeholder-survey}

\textbf{Hosted file}

\verb`Costs paper Figure 3 2.docx`  available at \url{https://authorea.com/users/312300/articles/509807-comparing-cost-of-intravenous-infusion-and-subcutaneous-biologics-in-covid-19-pandemic-care-pathways-a-brief-uk-stakeholder-survey}

\selectlanguage{english}
\FloatBarrier
\end{document}

