Abstract
11130 Background: Most inpatient chemo/immunotherapy (IC) is not reimbursed because of the diagnosis-related group code structure for reimbursement. We implemented the use of a novel objective scoring rubric to guide and automate IC stewardship at an academic cancer center to decrease the inappropriate use of IC especially at the end of life. Methods: We created a scoring rubric for non-formulary IC that includes type and phase of trial, FDA/NCCN approvals, performance status, line, and goal of therapy. Clinicians enter these criteria in a Redcap form which automatically calculates a score which is then verified by 2 disease specific physicians and a clinical pharmacist. If the threshold score is not met, IC is not approved for administration. IC that is on formulary and standard of care is automatically approved. We compared post-implementation year 1 (1/2022-8/2022) to post-implementation year 2 (1/2023-8/2023) on two primary outcomes: drug cost and utilization. Comparisons were assessed using the Wilcoxon Signed-Rank Test. Results: There was a total of 74 requests with 12% not approved in 2022 compared to 96 with 14% not approved in 2023. We compared the median values of the number of times each non-formulary IC was dispensed from January to August in both 2022 (median=6) and 2023 (median=2), p= 0.01. In 2022 the median of average monthly IC drug charges was $$840730 compared to $434586 in 2023 (p= 0.02). In 2022 the median of average monthly ICI drugs was($91651) compared to $55368.35 (p= 0.25) for 2023. The total annual charge of IC decreased by 44% from 2022 to 2023 with the total annual charge of immune checkpoint inhibitors decreasing by 26% (Table). Conclusions: Implementation of a novel objective scoring rubric for IC stewardship effectively reduced inappropriate administration, as evidenced by a significant decrease in the number of times non-formulary IC was dispensed and a substantial reduction in drug charges. The total annual charge of IC significantly decreased by 44% showing a sustained improvement over a 2 year period. This approach offers a promising strategy to optimize resource utilization and ensure appropriate utilization of IC, particularly in patients nearing the end of life. Further studies are warranted to evaluate the long-term impact of this intervention on patient outcomes and healthcare costs.[Table: see text]
Published Version
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