Implementation of a hemophilia management program improves clinical outcomes

Abstract

Introduction Hemophilia is a rare, inherited, coagulation disorder that impairs the body's ability to cease bleeding, making hemophiliacs susceptible to bleeding episodes. These patients often require multiple doses of clotting factor concentrates to help maintain hemostasis. In fiscal year (FY) 2016, Rush University Medical Center's drug expense for clotting factor concentrates totaled $4.6 million, which accounted for approximately 15% of the total drug budget. The Department of Pharmacy developed a Hemophilia Management Program (HMP) to improve care, reduce spending, and expand clinical pharmacy services. Prior to the HMP, the Department of Pharmacy completed drug acquisition and dispensing and no role existed for pharmacists as part of the comprehensive care team for the hemophilia population. The primary objective of this study was to evaluate clinical outcomes after implementation of clinical pharmacy services into the management of hemophilia patients in an interdisciplinary HMP. Methods Several areas for improved care and efficiency were identified prior to the implementation of the HMP: interdisciplinary education, clinical management and continuity of care, and formulary management. Results In total, implementation of the HMP resulted in a net savings of $2.7 million for clotting factor expenses for FY 2017. The cost savings based on clotting factor expenses resulted in a return on investment (ROI) of 20:1, exceeding the initial projections of a modest ROI of 3:1. In addition, these costs savings were realized with the average length of stay per patient staying within the previous margins. Finally, the HMP effectively reduced the need for blood transfusions per patient. Discussion Design and implementation of the HMP resulted in significant cost savings, improved efficiency, and enhanced clinical services for patients with hemophilia. This expansion of pharmacy services has become the first pharmacy‐led program in the country to not only reduce costs, but also improve clinical outcomes.

Hemostatic and antithrombotic stewardship programs: A toolkit for program implementation

“…Several publications have highlighted the impact of Hemostatic and Antithrombotic Stewardship Programs (Table 1). 9‐18 Of the 10 stewardship programs with reported outcomes, four programs had initiatives only focused on anticoagulation stewardship, four programs only focused on hemostatic stewardship, and two programs had a combination of select interventions involving anticoagulation and hemostatic stewardship. Reported anticoagulation interventions primarily involve anticoagulant prescribing and institutional protocol adherence, as well as focused efforts on heparin‐induced thrombocytopenia (HIT) management to reduce intravenous direct thrombin inhibitor (IV DTI) use 9‐12,17,18 .…”

“…Reported anticoagulation interventions primarily involve anticoagulant prescribing and institutional protocol adherence, as well as focused efforts on heparin‐induced thrombocytopenia (HIT) management to reduce intravenous direct thrombin inhibitor (IV DTI) use 9‐12,17,18 . Other programs aimed at the optimization of CFC use have reported optimization of patient selection for prothrombin complex concentrate (PCC) administration for anticoagulation reversal, preferential use of activated prothrombin complex concentrate (aPCC) over recombinant factor VIIa (rFVIIa) for hemophilia patients with inhibitors, CFC formulary management, implementation of 340B Drug Pricing Program for CFCs, and continuous infusion CFC administration 13‐16 . Notably, across all programs, pharmacists have been essential to program development and in most cases are heavily involved in direct patient care for patients receiving anticoagulants and CFCs.…”

“…Because many CFCs are administered in the emergency department or outpatient procedure areas, eligibility for the 340B Drug Pricing Program should be assessed. If eligible, the potential cost avoidance associated with developing a process to adhere to 340B program regulations and qualify for reduced pricing should be evaluated, recognizing that this requires 340B‐eligible administrations to be identified and tracked, dispensed from separate nonconsignment CFC supply, and reported to the CFC distributor 15 . Therefore, the volume of 340B‐eligible administrations should be considered when making this determination, because requirement for use of nonconsignment CFC supply for 340B programs increases the risk of medication expiration prior to use.…”

“…T A B L E 1 Structure and outcomes of existing hemostatic and/or antithrombotic stewardship programs [9][10][11][12][13][14][15][16][17][18]…”

Pharmacist Integration into the Hemophilia Treatment Centre: A Canadian Pilot Project to Optimize Treatment and Improve Cost-savings

“…For instance, two US studies have shown that involvement of a pharmacist in the management of recombinant and plasma derived factor therapies for hemophilia improves patient management and reduces associated costs. 8,9 As in Canada, in the US pharmacists are not typically part of the comprehensive care team for the hemophilia population. The Hemophilia Management Program 8 and The Factor Stewardship Program 9 were conducted to evaluate the impact of including a pharmacist in the management of hemophilia patients.…”