Category: Professional Posters
Purpose: Containing cost within the ambulatory infusion model is a high priority for many healthcare systems struggling with lower reimbursement and increased drug cost. An opportunity was identified within a rural ambulatory infusion center to reduce waste per dose by implementing a dose optimization strategy based on the hematology/oncology pharmacist association’s (HOPA) position statement of dose rounding all biological and cytotoxic substances within ten percent to the nearest vial size.
Methods: An assessment was done on the past biological and oncological agents in 2017 to determine a project cost savings for the infusion center if the policy was implemented. Key discussions were made with administration, our hematology/oncology physician, and the pharmacy and therapeutics (P&T) committee to discuss the position statement by (HOPA) and the research surrounding the topic. A policy was approved by the P&T committee and medical executive team to allow pharmacist to enact the dose rounding changes for both biological and cytotoxic substances of 10% for all agents. The pharmacists would modify the orders without having to consult the physician unless there was already a change in dosage based on other patient specific factors. The pharmacists would then document the intervention and how many units of the drug (e.g. mg, mcg) were saved.
Results: The projected cost savings of the infusion center from 2017 was estimated to be $33,866. Since the policies implementation in July of 2018 through March of 2019, $174,631.71 were saved based on this dosing policy on 235 difference patient orders. The projected savings estimation was exceeded by 515%. The orders were from many different practices and varied between both biological and cytotoxic. The highest cost savings on an individual drug was for brentuximab vedotin and most commonly dose rounded was paclitaxel.
Conclusion: Dose optimization for biological and cytotoxic substances has a large impact on infusion centers looking to save direct drug cost by reducing waste. Based on the results since implementation, the goal was vastly exceeded. This was attributed in part due to the infusion center volume increasing by 20% as well as many high costing agents being focused on. There has been no outcome or issues noted so far with this change. Overall, the policy change has been very well received and will continue to be used as a standard for the health system.