A presentation at the Association of Community Cancer Centers 2020 Virtual National Oncology Conference showed that moving chemotherapy treatment from an inpatient to an outpatient setting can save institutions “hundreds of thousands of dollars in drug costs.”
A few years ago, Ali McBride, PharmD, MS, clinical coordinator and supervisor of hematology/oncology at the University of Arizona Cancer Center, along with his colleagues, realized that some high-cost chemotherapy treatments being given at their institution could just as easily be given at home.
“More often than not, chemotherapy was being given in the inpatient setting just because it could be given in that setting,” said McBride.
So how could chemo-related costs be cut? According to McBride: “Institutions can save money they may otherwise lose in the inpatient setting by seeking reimbursement based on a buy-and-bill model, purchasing therapies under 340B (a program that provides hospitals with drugs at reduced costs) if they’re eligible, billing for waste, and gaining access to patient assistance programs.”
In short, patients could save money by getting their medication through assistance programs, and hospitals could save money by reducing drug waste and costs related to inpatient stays.
Put to the test
McBride decided to put together a team of physicians, information technology staff, nurses, and advanced practitioners, as well as clinical pharmacists, to shift certain chemotherapies from inpatient to outpatient. In 2015, the team started with the chemotherapy drug rituximab, enrolling 137 patients in their program. The transition to an outpatient setting wouldn’t affect the safety of the drug or its dosing regimen in any of the participants.
Clinical and staff pharmacists in particular “played leading roles” on the team, said McBride. Some of their key tasks were to screen patients for eligibility for outpatient chemotherapy, making sure patients could get to infusion centers and attend after-hours care, and setting up home infusion pumps.
“Another important piece our clinical pharmacists provide is staff and patient clinical education, and they also address adherence to supportive care medications and decrease inpatient drug waste, which has been key to the cost savings aspect of the program,” McBride said.
Over the course of four years, total savings for the 137 rituximab patients amounted to $925,000. More than half of that figure was related to drug cost savings through medication assistance programs. A reduction in inpatient stays also contributed to the impressive sum. This was especially helpful during the coronavirus pandemic, as hospital resources could now be reallocated to COVID-19 patients. In fact, physicians were more than happy to prescribe outpatient treatment when possible, McBride said.
Encouraged by their successes, McBride’s team now has a goal of transitioning 90% of patients receiving rituximab to outpatient settings.