{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T18:02:36Z","timestamp":1784916156249,"version":"3.55.0"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014805","name":"Roche Italia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014805","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Human Epidermal Growth Factor Receptor 2-positive (HER2+) breast cancer poses significant therapeutic challenges, particularly concerning treatment administration pathways and their associated costs. This study evaluates the managerial and economic impacts of different therapeutic administration scenarios for HER2-positive breast cancer patients, focusing on optimizing hospital workflows, resource utilization, and patient outcomes in Italian oncological centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A decision tree model was developed to simulate and compare five treatment administration pathways: Standard, Drug-Change, Drug Day, Dedicated Ambulatory, and Optimal Pathway scenarios. The model integrates patient and healthcare professional (HCP) activity and waiting times, infusion chair occupation, and direct and indirect costs. Sensitivity analyses assessed variability in model outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Switching from endovenous (EV) to subcutaneous (SC) administration substantially reduced patient throughput times and HCP workloads. The Optimal Pathway scenario yielded the highest resource optimisation, reducing HCP activity time by up to 48 hours, infusional chair occupational time by up to 150 hours, and patients\u2019 total time by up to 753 hours per 100 patients monthly. Cost analyses indicated significant savings in both direct and indirect cost for all the proposed scenarios in comparison to the Standard one.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The adoption of SC formulations and innovative pathway optimizations enhances treatment organizational efficiency and reduces both direct and indirect costs. These findings underscore the value of tailored approaches to administration based on the structural and organizational characteristics of individual oncology centers, aligning with current Italian healthcare reforms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0351548","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T17:38:48Z","timestamp":1784914728000},"page":"e0351548","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Decision tree model to assess consequences and costs associated with therapy administration pathways for patients with HER2+ breast cancer in Italian oncological centers"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5034-7446","authenticated-orcid":true,"given":"Giorgia","family":"Gribaudo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9609-9556","authenticated-orcid":true,"given":"Carla","family":"Fornari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ippazio Cosimo","family":"Antonazzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Generali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Carnaghi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Galimberti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Nardulli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Calamai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Marchesini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo Giovanni","family":"Mantovani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo Angelo","family":"Cortesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"pone.0351548.ref001"},{"key":"pone.0351548.ref002","unstructured":"AIOM-AIRTUM 2023."},{"key":"pone.0351548.ref003"},{"key":"pone.0351548.ref004","unstructured":"Gori S, Mantoan C, Miglietta F. A cura di: carcinoma mammario metastatico HER2-positivo: quali novit\u00e0 nel 2021? informazioni per pazienti, caregiver, cittadini. Informazioni per pazienti, caregiver, cittadini. 2021."},{"issue":"10087","key":"pone.0351548.ref005","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.1016\/S0140-6736(16)32417-5","article-title":"HER2-positive breast cancer","volume":"389","author":"S Loibl","year":"2017","journal-title":"The Lancet"},{"issue":"4","key":"pone.0351548.ref006","doi-asserted-by":"crossref","first-page":"800","DOI":"10.3390\/cancers16040800","article-title":"Next-generation HER2-targeted antibody\u2013drug conjugates in breast cancer","volume":"16","author":"BS Zimmerman","year":"2024","journal-title":"Cancers (Basel)"},{"key":"pone.0351548.ref007","year":"2023"},{"issue":"12","key":"pone.0351548.ref008","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1007\/s40267-023-01038-5","article-title":"The PHASTER Study: Economic and Organizational Impact of Subcutaneous (SC) Pertuzumab and Trastuzumab Fixed-Dose Combination (PH FDC SC) for Treatment of HER2+ Breast Cancer Patients","volume":"39","author":"E Munzone","year":"2023","journal-title":"Drugs Ther Perspect"},{"key":"pone.0351548.ref009","doi-asserted-by":"crossref","first-page":"102815","DOI":"10.1016\/j.ctrv.2024.102815","article-title":"Parp-inhibitors in the therapeutic landscape of breast cancer patients with BRCA1 and BRCA2 pathogenic germline variants: An Italian consensus paper and critical review","volume":"130","author":"A Zambelli","year":"2024","journal-title":"Cancer Treat Rev"},{"issue":"4","key":"pone.0351548.ref010","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1177\/1129729819884482","article-title":"PICC-PORT totally implantable vascular access device in breast cancer patients undergoing chemotherapy","volume":"21","author":"S Bertoglio","year":"2020","journal-title":"J Vasc Access"},{"issue":"1","key":"pone.0351548.ref011","doi-asserted-by":"crossref","first-page":"48","DOI":"10.33393\/ao.2024.3078","article-title":"Budget impact analysis of natalizumab biosimilar on pharmaceutical expenditure for the treatment of relapsing-remitting multiple sclerosis in Italy","volume":"11","author":"R Bergamaschi","year":"2024","journal-title":"AboutOpen"},{"issue":"2","key":"pone.0351548.ref012","doi-asserted-by":"crossref","first-page":"83","DOI":"10.32074\/1591-951X-837","article-title":"Full cost of diagnostic pathology for lung carcinoma in Italy: results from four Pathology Units","volume":"115","author":"C Lazzaro","year":"2023","journal-title":"Pathologica"},{"key":"pone.0351548.ref013","volume-title":"Gazzetta Ufficiale Della Repubblica Italiana Parte Prima Si Pubblica Tutti I Giorni Non Festivi Direzione E Redazione Presso Il Ministero Della Giustizia-Ufficio Pubblicazione Leggi E Decreti-Via Arenula 70-00186 Roma Amministrazione Presso L\u2019istituto Poligrafico E Zecca Dello Stato-Libreria Dello Stato-Piazza G"},{"key":"pone.0351548.ref014","unstructured":"Mandolfo S, Maggio M, Forneris G, Galli F. Giornale Italiano di Nefrologia Articoli originali Analisi dei costi delle infezioni correlate al catetere venoso centrale per emodialisi attraverso il sistema dei DRG, \u2018per conto del Gruppo di Progetto degli Accessi Vascolari della Societ\u00e0 Italiana di Nefrologia\u2019. 2019."},{"issue":"1","key":"pone.0351548.ref015","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1007\/s00415-023-11955-0","article-title":"Intravenous or subcutaneous natalizumab in patients with relapsing-remitting multiple sclerosis: investigation on efficiency and savings-the EASIER study","volume":"271","author":"M Filippi","year":"2024","journal-title":"J Neurol"},{"key":"pone.0351548.ref016","volume-title":"Work cost per minute [ISTAT 2018]","year":"2018"},{"key":"pone.0351548.ref017","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.ejca.2021.03.047","article-title":"Preference for the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection in patients with HER2-positive early breast cancer (PHranceSCa): A randomised, open-label phase II study","volume":"152","author":"J O\u2019Shaughnessy","year":"2021","journal-title":"Eur J Cancer"},{"issue":"4","key":"pone.0351548.ref018","article-title":"Health system review Italy","volume":"24","author":"A De Belvis","year":"2022","journal-title":"Health Systems in Transition: Italy"},{"key":"pone.0351548.ref019","volume-title":"Ministro della Salute Il Ministro della Salute"},{"key":"pone.0351548.ref020","volume-title":"Istituzione del Gruppo di Lavoro dedicato all\u2019Oncologia territoriale della provincia di Ferrara e adozione del progetto On-Connect. Oncologia Territoriale della provincia di Ferrara"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351548","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T17:38:53Z","timestamp":1784914733000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0351548"}},"subtitle":[],"editor":[{"given":"Vincenzo","family":"Auriemma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":20,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0351548","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]}}}