Evaluation of cost and infusion-related reactions among intravenous trastuzumab, subcutaneous trastuzumab, and trastuzumab biosimilars at an academic medical center.

INTRODUCTION: Trastuzumab is a vital treatment option for human epidermal growth factor 2 positive breast cancer. Since 2017, there have been 5 trastuzumab biosimilars approved for use. Despite hypotheses of infusion-related reactions among intravenous trastuzumab, subcutaneous trastuzumab, and trastuzumab biosimilars, there is minimal available literature comparing these agents. This evaluation will compare the rate of infusion-related reactions among these agents, evaluate our institution's utilization, and compare acquisition costs to determine if there is a potential cost savings by utilizing specific agents as our formulary preferred medication. METHODS: We retrospectively analyzed medical records to identify the incidence of infusion-related reaction after administration of intravenous or subcutaneous trastuzumab or trastuzumab biosimilars. Additionally, we conducted a cost analysis to identify potential cost savings by switching to an alternative institutional preferred agent. Infusion chair time was calculated to identify chair time savings with subcutaneous administration. RESULTS: There were 183 patients included in this study. Seven patients (3.8%) experienced an infusion-related reaction. The most utilized agent within our cohort was intravenous trastuzumab. During our study period, 181 patients received intravenous infusions, which could allow for substantial infusion chair savings by switching to trastuzumab/hyaluronidase, the subcutaneous formulation. Beyond the chair time, direct drug cost savings were also identified when comparing the costs of each of the evaluated medications. CONCLUSION: Subcutaneous trastuzumab or trastuzumab biosimilars do not pose a greater risk of infusion-related reactions compared to intravenous trastuzumab and may offer more affordable treatment options for breast cancer patients who qualify for trastuzumab therapy.

Conceptual frameworks and methods for advancing invasion ecology.

Invasion ecology has much advanced since its early beginnings. Nevertheless, explanation, prediction, and management of biological invasions remain difficult. We argue that progress in invasion research can be accelerated by, first, pointing out difficulties this field is currently facing and, second, looking for measures to overcome them. We see basic and applied research in invasion ecology confronted with difficulties arising from (A) societal issues, e.g., disparate perceptions of invasive species; (B) the peculiarity of the invasion process, e.g., its complexity and context dependency; and (C) the scientific methodology, e.g., imprecise hypotheses. To overcome these difficulties, we propose three key measures: (1) a checklist for definitions to encourage explicit definitions; (2) implementation of a hierarchy of hypotheses (HoH), where general hypotheses branch into specific and precisely testable hypotheses; and (3) platforms for improved communication. These measures may significantly increase conceptual clarity and enhance communication, thus advancing invasion ecology.

[Pressure ulcer risk and pressure ulcer prevalence in German hospitals and nursing homes]. / Dekubitusrisiko und Dekubitusprävalenz in deutschen Kliniken und Pflegeheimen.

In the spring of 2008, the "Institut für Medizin-/Pflegepädagogik und Pflegewissenschaft der Charité - Universitätsmedizin Berlin" conducted a nationwide prevalence study for the seventh time. Among other things, data was collected concerning pressure ulcer risk and pressure ulcer prevalence in German nursing homes and hospitals. 3345 residents from 37 nursing homes and 3391 patients from 19 hospitals were included in this study. Altogether, 3192 of them were at risk for pressure ulcers. In nursing homes, the percentage of persons at risk for pressure ulcer development was 62.5 percent, in hospitals 39.4 percent. 297 persons from the at risk group had at least one pressure ulcer. Pressure ulcer prevalence in hospitals was 12.7 percent and in the nursing homes 7.3 percent, respectively. Concerning pressure ulcer risk and pressure ulcer prevalence, there were considerable differences between individual hospitals and departments. Even with comparable risk groups, differences in pressure ulcer prevalence were found.

[Pressure ulcers: new data about risk, prevalence and places of development. Results of a study in German nursing homes and hospitals]. / Dekubitus: Neue Daten zu Risiko, Prävalenz und Entstehungsorten. Studienergebnisse aus deutschen Pflegeheimen und Kliniken.

In the spring of 2007 the "Institut für Medizin-/Pflegepädagogik und Pflegewissenschaft der Charité-Universitätsmedizin Berlin" conducted a nationwide prevalence study. Data were collected concerning pressure ulcer risk and pressure ulcer prevalence. In addition, data were gathered about place of development, prevalence rates for various clinical specialties within hospitals, and pressure ulcer location. Altogether, data from 6473 patients and residents were collected and analysed. In nursing homes the percentage of persons at risk for pressure ulcer development was 61.4 percent, in hospitals 38.0 percent. The prevalence of pressure ulcers grade 1 to 4 was 8.4 percent in nursing homes and 15.7 percent in hospitals. In nursing homes as well as in hospitals more than half of the pressure ulcers emerged within the same facilities. For 22.6 percent of pressure ulcers in hospitals the place of development remained unknown. In nursing homes this proportion was 5.6 percent.