Potential cost savings by dose down-rounding of monoclonal antibodies in a community cancer center

Abstract

Purpose Increasing new cancer cases and approval of effective but expensive new drugs extending survival have led to unsustainable cancer care costs. Potential cost savings by a hypothetical dose down-rounding project of monoclonal antibodies at a community-based cancer center is presented. Methods From October 2014 through October 2015, metastatic cancer patients receiving monoclonal antibodies at CHI-Health St Francis Cancer Treatment Center in Grand Island, Nebraska, were identified through electronic health records. A total of 11 different types of monoclonal antibodies that were administered during the study period were identified. Trastuzumab, ofatumumab, and obinutuzumab did not require dose-rounding; thus, they were excluded from the analyses. Available vial size(s) and costs per milligram per average wholesale price for each monoclonal antibody were recorded. Costs of actual amounts prescribed were compared to the costs of theoretically reduced ≤5% and ≤10% doses rounded to the nearest vial sizes. Reduced doses resulting in a decreased number of opened vials qualified for meaningful dose down-rounding and were included in the analysis. Average actual dose reduction percentage resulting in cost savings for both groups was also calculated. Results A total of 728 doses of eight monoclonal antibodies suitable for dose down-rounding were identified. Vial sizes of pembrolizumab and ipilimumab did not allow for a meaningful dose down-rounding. At the ≤5% dose down-rounding, 255 of 728 doses (35%) qualified with a potential annual cost savings of $220,793.80. At the ≤10% dose down-rounding, 526 of 728 doses (72%) qualified with a potential annual cost savings of $454,461.00. The average actual dose reduction was 2.4% for the ≤5% dose reduction group and 4.9% for the ≤10% dose reduction group. Overall average cost savings per qualifying dose reduction was around $865.00. More doses qualified for cost savings in the ≤10% dose reduction group. Significant differences between different monoclonal antibodies for dose rounding at either ≤5% (p = 0.002) or ≤10% (p < 0.001) were observed. Conclusion A practical dose down-rounding procedure may allow significant cost reduction in metastatic cancer setting, where the cure is not the goal. Drug waste can be avoided by convenient vial sizes or can even be eliminated by lyophilized forms like in trastuzumab. Our data reflect the monoclonal antibody use and potential cost savings with the proposed dose down-rounding approach in a community-based cancer program.

A real-world data approach to determine the optimal dosing strategy for pembrolizumab

“…16 Many studies have calculated wastage and costs for multiple expensive drugs, instead of performing an in-depth review of a single drug. 17–21 Some studies have examined a single drug’s retrospective usage data to explore cost-saving strategies including dose rounding, vial sharing, and estimating the ideal vial size; however, wastage data were not analysed. 22–24 Other studies have made extrapolations from short data collection periods, instead of making calculations from all patient-level data.…”

Comparative cost savings of biosimilar and dose rounding utilization in oncology care

“…In one community cancer center, projected annual savings of rounding to the nearest vial size of 11 monoclonal antibodies reduced costs by $220,793.80 if rounded by 5% and $454,461.10 by 10% per year. 7 In another analysis, cost savings of dose rounding seven biological agents (total of 126 doses) within 10% to the nearest vial size over a three-month period in an inpatient pharmacy was $124,434, which results in $497,736 saved annually. 5 An analysis investigating the benefits of using biosimilars found that their use reduced costs by about 40% compared with the reference product.…”

“…Rounding of drug doses to the nearest vial size when the difference is within 5% to 10% of the prescribed dose is an initiative employed by many institutions in order to reduce drug waste and cost. [4][5][6][7] The same measure is supported by the Hematology/Oncology Pharmacy Association and endorsed by the National Comprehensive Cancer Network. 6 Utilization of biosimilars in place of reference products is an additional approach to reduce the cost of oncology care.…”

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

“…This packaging of expensive infused drugs in quantities larger than needed is the cause of the wastage of medicines [19]. In this regard, it has been said that a Dose Rounding and Cost Reduction of Anticancer Agents policy implementation targeting the reduction of wastage may substantially reduce the expenditure on pharmacies and provide cost-benefit [18].…”

“…As per the report published in 2009 by the Canadian Cancer Society, newer anticancer drugs cost around 65,000 Canadian Dollars per course of treatment [17]. Apart from spending on research, a reason for the high cost of cancer treatment can be attributed to drug wastage [18]. The international guideline allows doses to be rounded (banded) for 5–10%.…”