Decreasing Costs and Optimizing Therapy of Erythropoietic Medications in a Hospital-Based Outpatient Cancer Treatment Center

The objectives of this study were to decrease the costs associated with erythropoietic medications and to optimize the use of these medications for patients with chemotherapy-induced anemia.

Methods

A cost-analysis was completed by performing cost calculations which determined that darbepoetin is the most cost-effective erythropoietic medication for one Cancer Treatment Center (CTC). Darbepoetin protocol and order forms were then developed for chemotherapy-induced anemia. The total costs of all erythropoietic medications at the CTC before and after protocol implementation were evaluated via purchasing data. Pre- and post-protocol retrospective chart reviews were completed to determine if protocol implementation resulted in therapy optimization.

Results

Forty-two patients were included in the pre-protocol review, and 21 patients were included in the post-protocol review. After darbepoetin protocol implementation, the average cost per month of erythropoietic medications decreased by approximately $30,500. The percent of patients receiving an appropriate initial dose doubled post-protocol (pre: 38% vs post: 76%). Appropriate monitoring of hemoglobin at baseline, monthly, and before dose adjustments increased to 100% post-protocol implementation; and there was a 50% increase in the percent of patients who had their hemoglobin monitored appropriately until stable.

Conclusions

A savings of approximately $335,000 was expected for the year of 2004 with the protocol use and darbepoetin as the erythropoietic agent of choice. The optimization of therapy should continue to improve via continued use of the darbepoetin protocol.