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Sustained Effects of Oncology Drug Cost Savings Initiatives: A VA Medical Center Outpatient Oncology Clinic Experience
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.
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.
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.
Hematology/Oncology Ordersets: A VA VISN 09 Wide Initiative
Purpose: Develop ordersets that seamlessly enter chemotherapy and biologics orders from CPRS to Pharmacy’s VISTA program (pVista) and CPRS notes within the VISN.
Background: Hematology/Oncology orders ranged from paper to CPRS within the VISN. CPRS orders must be reentered into pVistA by the pharmacist, a safety issue. Commercial proprietary programs were expensive and didn’t translate to pVistA. The COEMS program isn’t available within the VA may not interface seamlessly with pVistA. Therefore, VISN 09 Medicine Service Line’s Oncology Committee (MSLOC) decided to develop ordersets in CPRS that enter treatment notes and orders into pVistA.
Methods: Ordersets development was MSLOC highest priority (2015). MSLOC met monthly by phone identifying resources, reviewing available ordersets, and translating into pVistA. MSLOC developed a timeline for orderset implementation. Progress was discussed monthly and documented with screen shots. Site visits will be completed before 2017.
Data Analysis: Flowsheets included: 1. facility resources: treatment area, providers, staffing, oncology pharmacy, ADPACs, and CACs; 2. Mechanisms of orders and notes entering/ recording; 3. Dosing and safety checks; 4. Available ordersets.
Results: In 2016 our ordersets were established as a “best practice”. VISN issued a suspense to implement electronic ordersets by 2017. The timeline included: 1. team development (fall 2015)-providers, pharmacists, pharmacy ADPAC, CACs; 2. Review of available ordersets (winter 2016); 3. Orderset development (winter-spring 2016); 4. Progress assessment (spring 2016); 5. Site visits (summer 2016). Results varied by VISN site: 2/5 of VAs were already paperless; 4/5 are now paperless; 2/5 have completely updated ordersets; 1/5 still uses paper and have only begun implementing ordersets. 1/5 ordersets completed chemotherapy notes; this will be implemented at all sites.
Implications: Using limited VA resources, ordersets can seamlessly enter pVistA. Results vary within VISN sites; switching from paper to electronic requires a paradigm shift. In approximately 18 months ordersets have been revised and updated. Chemotherapy ordersets now are generated electronically in 4/5 VAs. A team of MSLOC, providers, and staff have implemented this. In 2017 MSLOC will quantify the effectiveness of the initiative to improve patient care, safety, and efficiency.
Purpose: Develop ordersets that seamlessly enter chemotherapy and biologics orders from CPRS to Pharmacy’s VISTA program (pVista) and CPRS notes within the VISN.
Background: Hematology/Oncology orders ranged from paper to CPRS within the VISN. CPRS orders must be reentered into pVistA by the pharmacist, a safety issue. Commercial proprietary programs were expensive and didn’t translate to pVistA. The COEMS program isn’t available within the VA may not interface seamlessly with pVistA. Therefore, VISN 09 Medicine Service Line’s Oncology Committee (MSLOC) decided to develop ordersets in CPRS that enter treatment notes and orders into pVistA.
Methods: Ordersets development was MSLOC highest priority (2015). MSLOC met monthly by phone identifying resources, reviewing available ordersets, and translating into pVistA. MSLOC developed a timeline for orderset implementation. Progress was discussed monthly and documented with screen shots. Site visits will be completed before 2017.
Data Analysis: Flowsheets included: 1. facility resources: treatment area, providers, staffing, oncology pharmacy, ADPACs, and CACs; 2. Mechanisms of orders and notes entering/ recording; 3. Dosing and safety checks; 4. Available ordersets.
Results: In 2016 our ordersets were established as a “best practice”. VISN issued a suspense to implement electronic ordersets by 2017. The timeline included: 1. team development (fall 2015)-providers, pharmacists, pharmacy ADPAC, CACs; 2. Review of available ordersets (winter 2016); 3. Orderset development (winter-spring 2016); 4. Progress assessment (spring 2016); 5. Site visits (summer 2016). Results varied by VISN site: 2/5 of VAs were already paperless; 4/5 are now paperless; 2/5 have completely updated ordersets; 1/5 still uses paper and have only begun implementing ordersets. 1/5 ordersets completed chemotherapy notes; this will be implemented at all sites.
Implications: Using limited VA resources, ordersets can seamlessly enter pVistA. Results vary within VISN sites; switching from paper to electronic requires a paradigm shift. In approximately 18 months ordersets have been revised and updated. Chemotherapy ordersets now are generated electronically in 4/5 VAs. A team of MSLOC, providers, and staff have implemented this. In 2017 MSLOC will quantify the effectiveness of the initiative to improve patient care, safety, and efficiency.
Purpose: Develop ordersets that seamlessly enter chemotherapy and biologics orders from CPRS to Pharmacy’s VISTA program (pVista) and CPRS notes within the VISN.
Background: Hematology/Oncology orders ranged from paper to CPRS within the VISN. CPRS orders must be reentered into pVistA by the pharmacist, a safety issue. Commercial proprietary programs were expensive and didn’t translate to pVistA. The COEMS program isn’t available within the VA may not interface seamlessly with pVistA. Therefore, VISN 09 Medicine Service Line’s Oncology Committee (MSLOC) decided to develop ordersets in CPRS that enter treatment notes and orders into pVistA.
Methods: Ordersets development was MSLOC highest priority (2015). MSLOC met monthly by phone identifying resources, reviewing available ordersets, and translating into pVistA. MSLOC developed a timeline for orderset implementation. Progress was discussed monthly and documented with screen shots. Site visits will be completed before 2017.
Data Analysis: Flowsheets included: 1. facility resources: treatment area, providers, staffing, oncology pharmacy, ADPACs, and CACs; 2. Mechanisms of orders and notes entering/ recording; 3. Dosing and safety checks; 4. Available ordersets.
Results: In 2016 our ordersets were established as a “best practice”. VISN issued a suspense to implement electronic ordersets by 2017. The timeline included: 1. team development (fall 2015)-providers, pharmacists, pharmacy ADPAC, CACs; 2. Review of available ordersets (winter 2016); 3. Orderset development (winter-spring 2016); 4. Progress assessment (spring 2016); 5. Site visits (summer 2016). Results varied by VISN site: 2/5 of VAs were already paperless; 4/5 are now paperless; 2/5 have completely updated ordersets; 1/5 still uses paper and have only begun implementing ordersets. 1/5 ordersets completed chemotherapy notes; this will be implemented at all sites.
Implications: Using limited VA resources, ordersets can seamlessly enter pVistA. Results vary within VISN sites; switching from paper to electronic requires a paradigm shift. In approximately 18 months ordersets have been revised and updated. Chemotherapy ordersets now are generated electronically in 4/5 VAs. A team of MSLOC, providers, and staff have implemented this. In 2017 MSLOC will quantify the effectiveness of the initiative to improve patient care, safety, and efficiency.
Oncology Drug Cost Savings Initiative: A VA Medical Center Outpatient Oncology Clinic (ONCVAMC) Experience
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.
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.
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.