Pharmacist Intervention Can Lower the Cost of Chemotherapy

A study in Japan found pharmacoeconomic benefits in complying with pharmacist interventions in chemotherapy regimens.

Several previous reports have shown that the management of individual chemotherapy regimens by pharmacists improves safety by reducing medication errors.

In a similar vein, pharmacist interventions into high-risk patients’ medication therapies have been shown to reduce treatment costs and total costs for diabetes, hypertension, dyslipidemia, depression, and asthma. One study published in 2013 even showed that educational intervention by pharmacists led to excellent cost-effectiveness within a Type 2 diabetes population.

Inspired by these positive findings, researchers in Kanazawa, Japan, undertook the first study of its kind to examine the pharmacoeconomic benefit of compliance with pharmacists in the management of individual chemotherapy regimens for cancer. Their objective was to pay particular attention to the comorbidity of neutropenia and its associated negative outcomes and costs.

Neutropenia is one of the major side effects of chemotherapy. Neutropenia is an abnormally low count of neutrophils, a type of white blood cell, used as an exclusion criterion in many chemotherapy regimens. Regimens for patients who develop neutropenia are modified often by prolonging the interval between courses of chemotherapy and sometimes by administering granulocyte colony-stimulating factor (G-CSF). Both modifications have potential pharmacoeconomic effects.

Oncology and Pharmacist Warnings

A prospective observational cohort study was performed at a community-based medical center. The study enrolled 374 patients receiving chemotherapy from the National Hospital Organization Kanazawa Medical Center from April 2010 to March 2011. This sample was narrowed down to 108 individuals who developed neutropenia at an exclusion criteria threshold. Finally, 12 individuals were excluded from the study for confounding factors (G-CSF prophylaxis, therapy cessation, or irregular attendance).

The final sample consisted of 96 patients with neutropenia who were prescribed chemotherapy for cancer. They were divided into a complying group (n = 58) for whom chemotherapy was suspended, and a non-complying group (n = 38) who continued chemotherapy despite pharmacists’ warnings.

Pharmacists Can Influence Chemotherapy

The management procedure used within this study was for the pharmacist to review administration schedules and drug doses and alert the doctor of any potential problems before an individual’s chemotherapy commenced. At this stage, the pharmacist ordered a neutrophil test if the doctor had not already ordered one. If neutrophil count met exclusion criteria, the pharmacist issued a warning to the doctor. If the doctor proceeded with chemotherapy anyway, the pharmacist issued a second warning.

This study measured and compared Relative Dose Intensity (RDI), an index of the intensity of a particular chemotherapy regimen. RDI is widely considered to be an appropriate index of the curative effect of anticancer treatment.

In addition, investigators measured and compared neutropenia-related direct medical costs (NRC) from the health insurance provider perspective.

Pharmacists Improve Cancer Patient Outcomes

Significant differences observed between complying and non-complying groups demonstrate that pharmacist input successfully reduced costs and potentially improved patient outcomes.

RDI for the complying group was 85.2% ± 10% versus 79.3% ± 15% for the non-complying group (P = .021). This is an important difference in potential curative effect, because in previous research, an RDI > 85% seems to predict improved long-term outcomes of chemotherapy.

The average NRC per patient for the complying group was $1944 ± $412, versus $4394 ± $837 for the non-complying group (P = .044). Univariate analysis showed that regimen compliance, neutrophil count, and leukemia influence NRC (P > .05). In multivariate analysis, only regimen compliance and leukemia were significant independent factors in NRC (adjusted r2 = 0.69; P < .001).

Use of G-CSF was similar in both groups (56.3% of complying group and 60.% of non-complying group; P = .08), but the duration of G-CSF therapy was significantly shorter in the complying group (10.7 ± 14.8 days) than in the non-complying group (20.7 ± 22.3 days; P = .049). Thus, extended G-CSF use appeared to be the main reason for higher NRC in the non-complying group.

A complete report on this study’s methodology and results is published in the Journal of Pharmaceutical Health Care and Sciences.