Anticancer prescription appropriateness: The APA score—A new method to assess anticancer prescriptions in the clinical setting.

Abstract

261 Background: Innovation is crucial in cancer care and access to innovation cannot be—only—economically ruled. We need new drugs, more effective and/or better tolerated to improve the care of our patients. In this context, we need new tools to evaluate the appropriateness of anticancer drugs prescriptions. In fact, the better the appropriateness, the better is the patient care, and the overall balance, including economically. Methods: A group of 9 pharmacists from university hospitals, general hospitals, and cancer centres joined under the umbrella of the European Fellowship for Pharmacists (EFP) association. The aim was to set up a common process in evaluating the appropriateness of anticancer drugs prescriptions (ADP), focusing on innovative drugs, but not only. Results: The backbone of our work was to put back the patient at the centre and not to focus on the costs as themselves. We defined a composite criterium called “value of an ADP” which included the costs of course in addition to several factors such as the existence of alternatives for a particular patient, the level of evidence from literature data, the existence of other indications, and several other items. First, a decision tree was elaborated, which allows systematic and standardized screening of ADP leading to early identification of ADP which do not necessitate thorough evaluation: prescription within the terms of either a market authorisation or a Temporary Therapeutic Protocol, or a Temporary Utilization Authorization (ATU), and not on a clinical trial. For the other prescriptions, an evaluation grid coupled to a score was set up. This APA Score (Anticancer Prescription Appropriateness) will allow to decide whether or not a ADP, in a particular clinical context and patient, should be judged as appropriate or not. Conclusions: At the time of this abstract: the evaluation grid has been discussed, modified, and validated with the participation of two clinical oncologists, specialized in Breast Cancer; the APA scoring is currently under testing by a team of methodologists and bio-mathematicians; and the grid and the APA Score will be tested in “real-life” within the departments of the people involved in the group by the end of 2011.