Dose rounding bevacizumab and its biosimilars to reduce drug waste in the oncology care model in a community oncology network.

Abstract

1529 Background: The Oncology Care Model (OCM) was a 6-year long Medicare value-based care (VBC) program that rewarded practices for decreasing TCOC compared to a benchmark price, while maintaining high-quality cancer care. Drug waste from partially used single dose vials (SDV) of expensive anti-neoplastic agents is a leading contributor to avoidable Total Cost of Care (TCOC) expenditures for payers. Dose rounding (DR) of biological anti-neoplastic agents, using recommendations (https://www.nccn.org/docs/default-source/clinical/order-templates/hopa.pdf?sfvrsn=3af91118_6) from the Hematology Oncology Pharmacists Association (HOPA) and endorsed by the National Comprehensive Cancer Network (NCCN), is a standard approach to mitigate the impact of drug waste. Many of the practices in The US Oncology Network (The Network) adopted a DR program for biologic agents in 2018 as a strategy to reduce drug waste and TCOC. We studied the impact of a DR initiative targeting bevacizumab and its biosimilars (B+B) on TCOC and drug waste expenditures for The Network practices participating in the OCM. Methods: Claims data for 14 practices in The Network participating in the OCM were assessed. Drug administration data for B+B was used to evaluate drug waste, total dose, TCOC, DR and the financial impact of drug waste reduction on TCOC from 2017 to 2021. Results: In 2017, prior to implementing DR, an average of 5.3% (range 4.6% to 5.5%) of the total dose of B+B was wasted, with ~25% of B+B administrations having waste in excess of 10% of the total dose. Implementation of the initiative led to a reduction of waste on 30% of the total administrations of B+B across 14 OCM participant practices in The Network. As a result of DR, B+B drug waste decreased by 55% to an average of 2.5% (range - 2.3% to 2.7%) of the total dose in 2021. Decreasing drug waste resulted in TCOC reduction of approximately $100 per member episode per month (0.97% of TCOC) for episodes with B+B administrations in the OCM. The highest waste reduction was seen with B+B administered for treatment of gastrointestinal cancers (colon, rectal, anal, gastroesophageal, or pancreatic cancers) compared to other cancer types (lung, brain, ovarian, etc.), and for B+B administrations where drug waste was greater than 10% of the total dose (~50% reduction). Conclusions: Drug waste contributes avoidable expenditures to the TCOC. Implementing strategies such as DR can offset the impact of drug waste and offer meaningful TCOC savings for VBC programs such as the OCM. A similar DR approach may be adopted for other high-cost biologic agents where drug waste results from partial use of SDVs.