Category: Professional Posters
Purpose: The pharmacy cost reduction team was challenged to find new ways to reduce pharmacy supply costs. Calcitonin acquisition costs had been steadily increasing over the past several years. A shortage of bisphosphonates contributed to an acute increase in calcitonin use for hypercalcemia prompting further evaluation from the pharmacy cost reduction team. Review of hypercalcemia cases revealed an opportunity to optimize dosing and subsequently drive down cost associated with hypercalcemia therapy.
Methods: The pharmacy performed an evaluation to determine how calcitonin was used. Opportunities for improvement were identified for both selection of appropriate patients requiring calcitonin and optimizing the dose of calcitonin as well as other treatment agents. A hypercalcemia of malignancy treatment pathway template was developed and vetted with appropriate physicians identified as users of calcitonin in the use evaluation. The pathway was reviewed and approved by Nephrology Council and the Pharmacy and Therapeutics (P&T) Committee and, following approval, was implemented fully in February 2019. A dosing cap for calcitonin was also approved. An alert was built within the computer order entry system to notify the pharmacists when the dosing cap is exceeded to prompt a change in dose. Follow-up evaluations were performed to determine the clinical and economic impact of the change.
Results: During the baseline period, October 2017 to September 2018, the average monthly spend for injectable bisphosphonates and calcitonin was $13,863. Following discussions with the appropriate stakeholders in October 2018, the average monthly cost of hypercalcemia treatment agents decreased to $4,636 per month for the time period of October 2018 to January 2019. After full implementation of the pathway and alert, the average monthly cost for hypercalcemia agents further decreased to $2,581 per month for the time period of February to May 2019. Overall cost savings from October 2018 through May 2019 is $79,980. Patients are prospectively monitored for adherence to the pathway and appropriate dosing of calcitonin. Retrospective review of all calcitonin patients has shown appropriate response to therapy without any complications.
Conclusion: Use of a hypercalcemia pathway and calcitonin dose limits has resulted in $79,980 of pharmacy supply cost savings in the first seven months and has optimized the treatment of hypercalcemia in this institution without negatively impacting patient care.