Background: Oncology drug costs continue to increase because of newly approved cancer treatments and indications for cancer treatment. To reduce or avoid the costs of cancer care, Veterans are seeking treatment through the VA. Antineoplastic medications are the most expensive
component of the pharmacy budget. During fiscal year (FY) 16 the Outpatient Oncology Clinic (ONCVAMC) cost savings initiatives (CSI) improved efficiency, cut costs, and maintained quality of care. ONCVAMC has continued monitoring these initiatives.
Methods: Effective CSI for oncology medications in FY17 included: dose rounding to nearest available vial size, grouping patients receiving the same drug to appointments on the same day, and effective procurement product selection. When appropriate, generic or lower priced contract products were ordered. Expiring high cost drugs were exchanged with other VA pharmacies to avoid waste. When the risk of adverse reaction was great, test doses were used prior to infusion.
Data Analysis: FY16 dose rounding to nearest commercially available vial: 41.2%; excluding antibody therapy from using actual body surface calculation in obese patients: 21.5%; purchasing generic or lower cost contract drugs: 21.5%; multi-dose vial drug formulations: 12.7%; grouping patients receiving the same drug to appointments on the same day: 5.1%; rounding to nearest vial size for the cycle: 4.9%; switching to oral agents for pre and post chemotherapy management: 1.6%.
Results: Savings for FY16 were greater than 6% of the total IV oncology drug expenditures with greater than $183,000 documented from CSI. From October-May 2017, CSI related savings exceed the savings for the entire FY16.
Implications: CSI implemented by oncology providers resulted in significant cost savings in FY16 and continue into FY17. CPRS based chemotherapy order sets, use of FDA-approved biosimilar medication, and use of newly FDA approved generic products resulted in cost savings for FY17. Expensive new cancer drugs and more indications for existing drugs are anticipated to increase oncology related procurement costs despite CSI. CSI reduced the rate of increase by providing mechanisms to decrease waste and minimize oncology drug expenditures. Oncology CSI lead to more efficient use of ONCVAMC resources.
