Impact of dose rounding of cancer therapy on cost avoidance: a pilot study
DOI:
https://doi.org/10.7175/fe.v14i4.658Keywords:
Cancer therapy, Dose rounding, Cost-savingAbstract
BACKGROUND: A significant and progressive cost rising in medical oncology due to the incorporation of novel and highly expensive drugs into clinical practice have been seen in the past ten years. Dose rounding is an option might be used in oncology settings to avoid extra cost. The purpose of this project is to determine the theoretical cost saving related to a dose rounding process for biological and chemotherapy agents in adult oncology settings and to determine the opinion of oncologists about dose rounding.
MATERIALS AND METHODS: Data was obtained prospectively during April 2011. All chemotherapy and targeted therapy orders prescribed in adult oncology outpatient clinics as well as in-patient wards have been collected. We considered rounding to an amount within 15% for targeted therapy and 10% for cytotoxic drugs. Chemotherapy dosing was calculated according to body surface area. Prescriptions that include cancer therapy in doses that might be rounded according to study criteria were identified.
RESULTS: Two hundred and thirty three orders of chemotherapy and targeted therapy were processed by Adult Oncology Satellite Pharmacy during the period of data collection. Forty percent of the collected prescriptions fulfilled the criteria. The potential cost savings from dose rounding per year was $192,800. Data was extrapolated from the determined monthly cost savings. The highest cost saving was for breast cancer orders $80,820 (42%), followed by colorectal cancer $47,965 (25%), while in non-Hodgkin's lymphoma cost savings was $ 45,107 (23%) and for other types of cancer that include non small cell lung cancer, prostate and ovarian cancer, in addition to head and neck cost savings was $18,867 (10%).
CONCLUSIONS: Our experience confirms the significant cost savings of cancer therapy by applying dose rounding to chemotherapy and biologic drugs prescriptions. While clinical impact of the suggested percentage needs to be evaluated.
References
Sullivan R, Peppercorn J, Sikora K, et al. Delivering affordable cancer care in high-income countries. Lancet Oncol 2011; 12: 933-80; http://dx.doi.org/10.1016/S1470-2045(11)70141-3
Jarkowski A 3rd, Nestico JS, Vona KL, et al. Dose rounding of ipilimumab in adult metastatic melanoma patients results in significant cost saving. J Oncol Pharm Practice 2013 [Epub ahead of print]; http://dx.doi.org/10.1177/1078155213476723
Fasola G, Aita M, Marini L, et al; Drug waste minimization and cost-containment in medical oncology: Two year results of a feasibility study. BMC Health Serv Res 2008; 8: 70; http://dx.doi.org/10.1186/1472-6963-8-70
Field K, Zelenko A, Kosmider S, et al. Dose rounding of chemotherapy in colorectal cancer: an analysis of clinician attitudes and the potential impact on treatment costs. Asia Pac J Clin Oncol 2010; 6: 203-9; http://dx.doi.org/10.1111/j.1743-7563.2010.01297.x
Dooley MJ, Singh S, Michael M. Implications of dose rounding of chemotherapy to the nearest vial size. Support Care Cancer 2004; 12: 653-6
Winger BJ, Clements EA, DeYoung JL, et al. Cost saving from dose rounding of biologic anticancer agents in adults. J Oncol Pharm Pract 2011; 17: 246-51; http://dx.doi.org/10.1177/1078155210366171
Patel S, Le A. Rounding rituximab dose to nearest vial size. J Oncol Pharm Pract 2013; 19: 218-21; http://dx.doi.org/10.1177/1078155212462439
Gurney H. Dose calculation of anticancer drugs: a review of the current practice and introduction of an alternative. J Clin Oncol 1996; 14: 2590-611
Sawyer M, Ratain MJ. Body surface area as a determinant of pharmacokinetics and drug dosing. Invest New Drugs 2001; 19: 171-7
Nava-Ocampo AA, Alarcón-Almanza JM, Moyao-García D, et al. Undocumented drug utilization and drug waste increase costs of pediatric anesthesia care. Fundam Clin Pharmacol 2004; 18: 107-12
Diehl LD, Goo ED, Sumiye L, et al. Reducing waste of intravenous solutions. Am J Hosp Pharm 1992; 49: 106-8
Favier M, Fliche E, Bressolle F. Economic benefit of a centralized reconstitution unit of cytotoxic drugs in isolator. J Oncol Pharm Pract 1996; 2: 182-5; http://dx.doi.org/10.1177/107815529600200308
Gillerman RG, Browning RA. Drug use inefficiency: a hidden source of wasted health care dollars. Anesth Analg 2000; 91: 921-4
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal. The Publication Agreement can be downloaded here, and should be signed by the Authors and sent to the Publisher when the article has been accepted for publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (see The Effect of Open Access).
- Authors are permitted to post their work online after publication (the article must link to publisher version, in html format)
