Introduction

The environmental sustainability of healthcare is a major issue. Subcutaneous (SC) infliximab (IFX) was approved in 2020 by EMA. This offers patients the opportunity to self-administer their treatment at home, save significant time and increase productivity by not taking time off work to attend their infusion. In addition, there is potential reduction in carbon footprint for both patients and the NHS. Previous studies have reported on clinical outcomes of switching from IV to SC IFX. We aim to report other patient benefits associated with switching to SC IFX.

Method

As part of a phase IV interventional study (SWIMSUIT), we offered patients on IV IFX the opportunity to switch to SC IFX. Patients who agreed to switch were followed up every 12 weeks for 24 weeks. In addition to baseline clinical data, we collected data on demographics, employment status, mode of travel to the infusion unit and the total time taken for patients (leaving home to returning home). We calculated the distance travelled by the patient to and from the infusion unit and used this to estimate the average cost per return journey and associated carbon dioxide (CO₂) emission (based on fuel consumption of a medium car producing 0.282 kgCO₂/mile). Treatment satisfaction was captured by a validated questionnaire 4 weekly during the study period.

Results

Out of the 204 patients approached, 120 switched to SC IFX. The two most common reasons for declining to switch were concerns about having a flare (24%) and reluctance to self-inject (23%). The median age was 38 and 57% of the patients were male. 81% were in employment. The median time taken by patients (leaving home to returning home) to receive their infusions was 180 minutes (IQR 60 to 660). Majority of the patients travelled by car to the infusion unit (83% car, 14% public transport, 2.5% walked/cycled and 0.5% unknown). 24% of those who travelled by car were driven by family or friends. The median annual cost encountered by patients coming to the infusion unit was £49.4 (29.5 – 205.6). This was slightly higher for those on an accelerated regimen (figure 1a). The estimated median annual CO₂ emissions for the driving group was 27.1 kgCO₂ (34.5 kgCO₂ for those on an accelerated regimen). At week 24, 96.3% of the patients reported being satisfied with SC CT-P13 (figure 1b).

Conclusion

SC IFX is well-accepted by IBD patients. In addition to potential therapeutic benefits, it provides patients a greater choice, convenience, significant annual savings for some and reduces patients’ carbon footprint, however, this needs to be offset against the carbon footprint of homecare deliveries.