Cost avoidance from dose rounding biologic and cytotoxic antineoplastics

VanDyke, Thomas H.; Athmann, Paul W.; Ballmer, Corey M; Kintzel, Polly E

doi:10.1177/1078155216639756

Cited by 14 publications

(12 citation statements)

References 28 publications

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“…Lastly, our analysis did not consider dose rounding, because such practice cannot be reliably determined from claims data. This may overestimate costs associated with discarded drugs, with research showing that dose rounding can reduce drug wastage ( 31 ). Nevertheless, our estimates from the perspective of payers and patients in private insurance add important information to the literature as the study by Bach et al ( 2 ) derived their estimates from Medicare payment ( 2 ), which tend to have lower markups than private payers.…”

Section: Discussionmentioning

confidence: 99%

Financial Burden of Discarded Weight-based Antineoplastic Drugs to Payers and Patients in the Private Insurance Market

Shih

Zhao

Schrag

et al. 2021

JNCI Cancer Spectrum

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Background To estimate insurance payments and patient out-of-pocket (OOP) expenses associated with discarded weight-based intravenous anti-neoplastic drugs for privately insured US adult cancer patients. Methods We identified patients who received weight-based anti-neoplastic drugs from 2017 MarketScan Health Risk Assessment (HRA) linked to claims data. Using weight information in the HRA, we derived the recommended dose and calculated the percentage of drugs discarded. We applied beta regression to determine factors associated with the discarded percentages. To compare patients with and without high-deductible plans, we employed generalized linear model and two-part model to examine insurance payment and OOP expense, respectively. All statistical tests were 2-sided. Results Of 27,350 claims for 58 weight-based anti-neoplastic drugs from 1,970 patients, the median discarded percentage was 9.8% (mean = 12.8%, SD = 10.5%). Aside from drug and tumor type, statistically significantly higher discarded percentages were found for patients in the lowest weight group (5.5%, 95% confidence interval = 4.7% – 6.4%; P < .001, weight <150 vs. ≥200 lb). Private payers spent $5,090 per patient in 2017 on discarded weight-based anti-neoplastic drugs and patients’ mean OOP expense on discarded drugs was $63. 39.7% of patients had high-deductible plans. The adjusted mean OOP expense for discarded drugs was statistically significantly higher for those in high-deductible plans ($95 vs. $47, P < .001). Conclusions Private insurers incurred substantial financial burden from discarded weight-based anti-neoplastic drugs. Although OOP expenses of discarded drugs were modest for most privately insured cancer patients, approximately 5% spent over $400 on the discarded drugs. Policies designed to reduce drug waste from single-dose, weight-based anti-neoplastic drugs should evaluate their financial consequences for payers and patients.

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Section: Discussionmentioning

confidence: 99%

Financial Burden of Discarded Weight-based Antineoplastic Drugs to Payers and Patients in the Private Insurance Market

Shih

Zhao

Schrag

et al. 2021

JNCI Cancer Spectrum

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“…Disagreement for usage in all patients was the greatest, highlighting needs for exclusion criteria. Studies that attempted DB have excluded the following patients from use: paediatrics, 44 multiple co-morbidities and pharmacokinetic issues, 39 geriatrics with poor renal function, frail patients, 13 and extreme weights. 45 Nurses and pharmacy staff in our study were more accepting towards a ±10% dose variance, compared to the more cautious physicians.…”

Section: Incorporate Charging Unit For Drugs Into Deciding Banded Rangesmentioning

confidence: 99%

Determining acceptance and perceptions of chemotherapy dose banding in an ambulatory cancer centre

Ho,

Jo Lene,

Yap

et al. 2023

J Oncol Pharm Pract

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Introduction Despite the advantages of dose banding (DB) and numerous plans to adopt this practice, uptake of DB is still poor. As opinions of healthcare professionals were deemed essential in DB's acceptance, this study surveyed key stakeholders to determine the acceptance, facilitators, and barriers of DB in chemotherapy to improve its implementation. Methods A cross-sectional study at the National Cancer Centre Singapore, involving physicians, nurses, and pharmacy staff, was conducted in February 2022. The Theory of Planned Behaviour was adapted to design a survey questionnaire to obtain the acceptance, facilitators, and barriers of DB. Additional questions on maximum acceptable dose variance and essential criteria for selecting drugs for DB were included. Results A total of 93 participants responded, with a mean 9.75 ± 7.37 years of clinical experience. Less than half have heard of DB while few had prior experience. Drug cost was the top selection criteria for DB, followed by toxicity, therapeutic index, frequency of use and drug wastage. Acceptance rate of DB was 41.9%, with majority agreeing to use DB in various drugs but to determine patient suitability before usage. Being greatly affected by subjective norms, having a positive outlook for DB's impacts, and no effect on toxicity significantly influenced acceptance. Conclusion Prior to implementing DB at the institutional level, educational training addressing concerns over toxicity, and providing technological support can help improve acceptance. Future studies can involve patients’ perspectives and more institutions for greater diversity in opinions.

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“…The infusion of costly biological anticancer agents and oral chemotherapy has led to a significant and exponential rise in the cost of cancer treatment over the years [7]. The speakers at a workshop conducted by the Institute of Medicine’s National Cancer Policy Forum on “Delivering Affordable Cancer Care in the 21st Century” in October 2012 comprehended that a rise in the cost of emerging cancer therapies and the introduction of technological advancement rendered cancer treatment unaffordable with no evidence of improved outcomes among cancer patients [8, 9]. The exponential increase in the price of anticancer drugs and accompanying expenditure has raised concerns regarding the overuse of drugs.…”

Section: Introductionmentioning

confidence: 99%

Dose Rounding and Cost Reduction of Anticancer Agents at King Fahad Medical City, Saudi Arabia: A 1-Year Feasibility Study

Bany Hamdan,

AlBanyan,

Alwuhayd

et al. 2023

Saudi J Health Syst Res

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Introduction: The exponential increase in the price of anticancer drugs has warranted looking for a cost-saving measure to counter their price rise. We aim to study the impact of dose rounding of biological and anticancer agents within a range of 10% of the ordered dose. Method: The study involved patients treated with anticancer agents between January 2018 and December 2018 at King Fahad Medical City’s (KFMC) comprehensive cancer center. An anticancer medication database was created for data collection and processing. All the eligible orders were processed by hematology and oncology physicians. A performance improvement methodology was used. The dose rounding was based on the patient’s preprinted order and the nearest available vial size. The potential impact on cost was measured in Saudi Riyals (SAR). Descriptive statistics were applied for data analysis and interpretation of the results. Results: A total of 26 anticancer medications were used for treating cancer patients, and 208 prescriptions were found to be eligible for dose rounding. Brentuximab was among the drugs, showing the highest cost saving at an estimated 20,600 SAR. In addition to reducing wastage and cost of medications, 7 min were saved per preparation episode in the post-intervention period. Conclusion: Data reflected that dose rounding of chemotherapy and biological agents up to a limit of 10% is a feasible approach and could potentially save extra cost and wastage of medications in the comprehensive cancer center of KFMC.

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Cost avoidance from dose rounding biologic and cytotoxic antineoplastics

Cited by 14 publications

References 28 publications

Financial Burden of Discarded Weight-based Antineoplastic Drugs to Payers and Patients in the Private Insurance Market

Financial Burden of Discarded Weight-based Antineoplastic Drugs to Payers and Patients in the Private Insurance Market

Determining acceptance and perceptions of chemotherapy dose banding in an ambulatory cancer centre

Dose Rounding and Cost Reduction of Anticancer Agents at King Fahad Medical City, Saudi Arabia: A 1-Year Feasibility Study

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