Background: A systematic literature review (SLR) was conducted to assess the use of independent injections (self/partner/home-administered) as an alternative to healthcare-setting injections for chronic diseases. The primary objective was to identify studies reporting on independent injection of somatostatin analogues (SSAs). Comparative evidence on independent injection of other medications was examined as a secondary objective.
Methods: MEDLINE/Embase/the Cochrane Library were searched for records published between January 2001September 2021, using terms for independent injection. Congresses (20192021) and SLR bibliographies were also hand-searched. Abstracts/full-text publications were reviewed by two independent reviewers. Studies were eligible if they reported on efficacy/effectiveness, adherence, safety, economic or patient-reported outcomes in populations receiving independent injections of SSAs (primary objective) or other monthly subcutaneous treatments (secondary objective). Studies investigated under the secondary objective were required to include a comparator in the healthcare setting.
Results: 3.430 unique records were screened, of which 12 studies, comprising
183,921 patients, were included, all reporting on SSAs (lanreotide or octreotide). No studies were identified to support the secondary objective. In four studies reporting comparative efficacy/effectiveness, independent injection was associated with equal/greater disease control in patients with acromegaly and neuroendocrine tumors (NETs) compared with healthcare-setting administration. Treatment adherence, defined as successful injection administration, was shown in 74%93% of patients with acromegaly receiving independent injections in two studies, both assessing lanreotide. A higher proportion of injection-site reactions was observed in patients self-injecting lanreotide compared with partner injections (19% vs 2%, P<0.05). Two studies reported non-serious adverse events, which were rare in both the independent and healthcare-administration settings. Preference for independent injection varied between studies/disease indications, ranging from 4%100% across five studies, with patients citing increased autonomy and convenience for preference over healthcare-setting administration. Lower anxiety, perceived safety, and the ability to communicate with a healthcare provider (HCP) were factors underlying a preference for healthcare-setting administration. Self- or partner-injection was associated with economic savings compared with the healthcare setting across five studies, including nurse, travel, and administration time.
Conclusions: Independent injection is similar to the healthcare setting regarding efficacy/effectiveness, adherence, and safety outcomes. Patient preferences for administration setting varied and may reflect the need for improved patient education/training, or home care program support for those where independent injection is a preferred/suitable option.
Self- or partner-injection also provided cost savings. Our findings provide a basis to understand outcomes related to independent injection and empower patients to discuss optimal treatment choices with their HCP.
21 May 2022 - 24 May 2022