Time and cost to healthcare providers and sites associated with preparation and administration of subcutaneous vs intravenous nivolumab for the treatment of cancer: a time-driven activity-based costing study

Background: Subcutaneous (SC) administration of oncology therapies offers increased convenience for patients and healthcare providers (HCPs) and reduced administration costs when compared with intravenous (IV) delivery. SC nivolumab (NIVO), in combination with hyaluronidase-nvhy (NIVO + hyal SC), demonstrated noninferiority to NIVO IV in key efficacy and pharmacokinetic outcomes along with a comparable safety profile in the CheckMate 67T trial. To understand the potential impact of NIVO + hyal SC on clinical practice, we evaluated time and resource utilization, along with corresponding costs, associated with administration of NIVO IV vs NIVO + hyal SC as treatment for previously approved adult solid tumors.

Methods: Time-driven activity-based costing methods were used to examine time and costs associated with constituting and administering a dose of NIVO + hyal SC vs NIVO IV. Process maps and corresponding resources (ie, equipment, medications, personnel, physical plant) per administration were estimated by a modified Delphi panel of experienced healthcare providers (4 oncologists, 2 pharmacists, 1 nurse) proficient with both administration types of NIVO. All estimates were consensus-driven; associated unit costs were derived from publicly available US sources and expressed in 2025 US dollars.

Results: HCPs reported that preparation and administration of NIVO IV required21.0 (range, 15.0–27.0) minutes and 69.5 (53.0–93.0) minutes, respectively, for a total of 90.5 (68.0–120.0) minutes. In contrast, NIVO + hyal SC required 19.0 (range, 14.0–24.0) minutes and 14.3 (11.3–15.3) minutes, respectively, for a total of 33.3 (25.3–39.3) minutes. NIVO + hyal SC reduced NIVO IV preparation and administration times by 63.2% (range, 62.8%–67.3%), which resulted in a reduced patient visit burden of 57.2 (42.7–80.7) minutes. Time savings were driven by reductions in nursing time by 46.9%, medical assistant time by 68.8%, and pharmacy/tech time by 9.5%. Acquisition costs of NIVO were the same for both formulations. Collectively, costs associated with all other resources required to prepare and administer NIVO IV were $95 (range, $70–$115) and $41 ($28–$49), respectively, for a total of $135 ($98–$164). Corresponding total costs for NIVO + hyal SC were $92 (range, $71–$109), $20 ($15–$21), and $112 ($86–$130), respectively. Accordingly, NIVO + hyal SC was expected to reduce costs of preparation and administration by 17%. Cost differences were primarily attributable to reduced time requirements for HCPs—specifically, pharmacists and nurses.

Conclusions: Findings suggest that use of NIVO + hyal SC reduces time and cost required from HCPs to prepare and administer therapeutic doses vs NIVO IV, thus increasing efficiency of care for both HCPs and patients. Such efficiencies could yield substantial and meaningful cumulative time and cost savings at both the patient and institutional levels.

Karishma Shelley is the director of Global Health Economics and Outcomes Research at Bristol Myers Squibb, driving evidence generation and value demonstration to inform payer and provider decision making. She leads strategic pan-tumor initiatives focused on demonstrating clinical and economic value across oncology. A pharmacist by training, Karishma holds a master’s degree in applied health economics and outcomes research from Thomas Jefferson University.