The Cost-saving Potential of Dose-rounding Pediatric Anti-cancer Therapies

By 2030, the total cost of oncology-health care is projected to reach $246 billion. These costs not only implicate the families and insurance plans of patients with cancer, but also health-system pharmacy budgeting as well. Therefore, pharmacists must find innovative health care solutions to combat the hefty financial burden.

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A new study published in the Journal of Oncology Pharmacy Practice discussed the potential cost savings of dose-rounding anti-cancer agents in the pediatric population. The Hematology/Oncology Pharmacy Association (HOPA) previously published a statement regarding the cost benefit of dose-rounding in adult patients. However, HOPA lacked evidence from studies on pediatric populations and, therefore, omitted pediatric dose-rounding from its statement.

In this context, dose-rounding pertains to increasing or decreasing the anti-cancer medication by an “acceptable” percentage value to the nearest vial size. The percentage usually falls within 5%-10%. HOPA suggested a maximum of 10% in its previous statement.

The practice of dose-rounding oncology medications has numerous benefits, including:

• Providing cost savings directly to the health care system by reducing total number of vials on each medication order.
• Improving the efficiency of medication ordering for pharmacists and clinicians.
• Reducing medication errors (rounded values are easier to convert to measurable volumes).
• Limiting the number of wasted vials (most anti-cancer medications are available as single-dose vials that have a limited timeframe in which they can be dispensed after puncture).

The study consisted of 347 participants and took place over a 4-year period. Researchers chose a duration of 4 years to mitigate year-to-year changes in patient volumes and diagnoses.

To calculate potential cost savings, researchers instructed pharmacists to round medication orders down to the nearest vial. Researchers only collected data points if the rounded dose fell within 10% of the original calculated dose. They calculated monetary savings for each medication by multiplying the wholesale cost of the single dose vial by the number of vials saved.

From the study, investigators calculated an overall potential cost savings of $1,126,000 over the 4-year period ($282,000 per year and $3200 per patient). Investigators believe this study demonstrates one of the “largest cost savings evaluations of dose-rounding performed at a children’s hospital.”

However, although the study shows promise for pediatric dose-rounding in the future, additional studies on how dose-rounding impacts pharmacokinetics and pharmacodynamics is necessary. These changes may result in altered safety and therapeutic efficacy of these agents.

In the meantime, pharmacists should continue to stay up to date on recommendations outside the scope of medication monitoring. In addition to providing clinical input, overcoming barriers to care, such as cost, remains an important contribution pharmacists make to improving patient outcomes.

About the Author

Kimberly Ma is a 2024 PharmD candidate at the University of Connecticut.

Reference

Graff JM, Cramer J, Kolb LL, Agherrabi Z, Burgess M. Evaluation of potential cost savings through chemotherapy and biotherapy dose-rounding at a pediatric institution [published online ahead of print, 2023 Jun 22]. J Oncol Pharm Pract. 2023;10781552231184583. doi:10.1177/10781552231184583