Purpose: To determine the effect of Chemotherapy Review Subcommittee on cost savings at the ONCVAMC.
Background: Oncology costs have dramatically increased secondary to newly approved cancer drugs. To reduce or avoid the costs of cancer care, more Veterans are seeking treatment through the VA. ONCVAMC cancer patients under treatment have increased ~15%/year for 10 years. Antineoplastic medications are the most expensive component of the pharmacy IV budget. To reduce costs, ONCVAMC oncology providers have implemented cost savings initiatives (CSI).
Methods: CSI for oncology medications included: dose rounding to nearest available vial size; excluding antibody therapy from using actual body surface calculation in obese patients; grouping patients receiving the same drug to appointments on the same day; using multi-dose vials; purchasing generic or lower priced contract drugs. When appropriate, oral agents with comparable effectiveness were substituted for IV pre and post chemotherapy symptom management. Savings are reported as percentage of IV oncology drug expenditures. Cost savings were tracked and reported monthly to the subcommittee.
Data Analysis: Dose rounding to nearest commercially available vial- 58%; excluding antibody therapy from using actual body surface calculation in obese patients- 17%; rounding to nearest vial size- 8.1%; purchasing generic or lower cost contract drugs- 6.6%; grouping patients receiving the same drug to appointments on the same day- 4.9%; multi-dose vial drug formulations- 4.8%; switching to oral agents for pre and post chemotherapy management- 0.6% (implemented 4/2016).
Results: Savings from 10/2015 through 5/2016 were greater than 3% of the total IV oncology drug expenditures. By extrapolation 2016 cost savings will be ~5%. The overall cost savings from 10/1/2015 to 5/31/2016 was $97,061.
Implications: CSI by oncology providers resulted in significant cost savings. CPRS based chemotherapy order sets, implemented 4/2016, will further increase cost savings. However, since newer, more efficacious antineoplastics are more expensive and the ONCVAMC Veterans receiving treatment increase ~15%/year, CSI will not reduce the oncology related costs, but will reduce the rate of increase. Oncology CSI will lead to more efficient use of ONCVAMC expenditures.
