Study Supports Pharmacists’ Roles in Ensuring Appropriate Use of Oral Oncolytics

New study findings from CPS Solutions, LLC, highlight the roles pharmacists can play in appropriate use of oral oncolytics, particularly when embedded in health system special pharmacy (HSSP) oncology clinics. The findings were presented in a poster at the Pharmacy Quality Alliance 2024 Annual Meeting in Baltimore, Maryland, from May 14 through 16.

Pharmacists who are embedded within a HSSP can utilize their clinical expertise to intervene in medication therapy management challenges. Such interventions by pharmacists have been associated with improved patient outcomes and cost savings. For instance, according to the investigators, the average cost savings per pharmacist intervention for oncology medications ranges from approximately $8100 to $11,000.

Image credit: Valeri Luzina | stock.adobe.com

Further understanding the practices that lead to the best cost savings can help strengthen the benefits provided by pharmacists to patients and the broader health care system. To this aim, researchers designed a study to determine the impact of HSSP pharmacists’ interventions on cost savings for oral oncolytics in a community oncology center.

The study was a single center, retrospective, observational design to analyze interventions made by an oncology pharmacist for patients who received at least 1 oral oncolytic medication between September 2019 and March 2023 at Summa Health Cancer Institute in Akron, Ohio. Physician-accepted interventions that resulted in dose reductions, held doses, changes in therapy, or changes in frequency were evaluated and the total cost savings were calculated. A 10% validation of cost savings interventions was completed using the National Community Oncology Dispensing Association Cost Avoidance and Waste Tracker.

Patients were included if they had a cancer diagnosis, were receiving clinical management by an embedded HSSP oncology pharmacist and had 1 or more completed interventions documented as adverse drug reaction, drug utilization review, lab, or regimen that resulted in dose reductions, held doses, changes in therapy, or changes in frequency. Patients were excluded if they were younger than 18 years of age or were receiving clinical management for a cancer medication administered via any route other than oral.

Key end points included intervention types, recommendations, and reasons; total cost savings; average cost savings per intervention; total cost savings per intervention type; and top 5 medications with the highest cost savings.

According to the investigators, a total of 92 completed interventions were analyzed, 55 of which (59.8%) resulted in cost savings for 44 different patients. Cost savings were associated with 24 unique medications.

Four intervention types were identified: regimen (49%), adverse drug reaction (42%), lab (5%), and drug utilization review (4%). Furthermore, there were 8 different intervention reasons identified: side effects (41), renal issues (7), drug interactions (2), inappropriate dosing schedule (1), wrong indication (1), inappropriate therapy (1), held due to COVID-19 (1), and uptitration (1). Finally, there were 4 different intervention recommendations identified: change frequency (1), change therapy (6), hold dose (22), and reduce dose (29).

The total amount of cost savings associate with the pharmacist interventions was calculated to be $700,503, and the average cost savings per intervention was $12,508. The total cost savings per intervention were also calculated to be $399,994 for reduce dose; $217,071 for hold dose; $65,501 for change frequency; and $17,937 for change therapy.

Additionally, researchers identified the top 5 medications with the highest cost savings. These were crizotinib (Xalkori; Pfizer) with $220,043, venetoclax (Venclexta; AbbVie and Genentech) with $83,462, ribociclib (Kisqali; Novartis) with $70,180, palbociclib (Verzenio; Lilly) with $37,048, and ixazomib (Ninlaro; Takeda) with $34,272.

These findings provide further evidence that embedded pharmacists within HSSP oncology settings can have drastic impacts on appropriate use of oral oncolytics. Particularly as value-based health care models become more widespread, these types of interventions will be important to demonstrate the value of pharmacist-embedded HSSPs.

The investigators noted that further research is needed to understand the impacts of these outcomes on patients outcomes, such as mortality, health care utilization, progression-free survival, and quality of life. They added that other pharmacist interventions could have resulted in cost savings despite not being included in the study, and cost savings for external pharmacy fills were likely undercalculated due to unavailable data on durations of therapy and number of dispenses.

Reference

Rees M, Giavatto C, Medina AL, Mourani J, Fitzpatrick C. Maximizing Cost Savings: The Impact of Specialty Pharmacist Interventions at a Community Oncology Center. Poster. Presented at: PQA 2024 Annual Meeting. Baltimore, Maryland; May 14-16, 2024.