Potential Cost Avoidance Research Articles

A cost comparison of pembrolizumab: Fixed and weight-based dosing.

Pembrolizumab, an immune checkpoint inhibitor, indicated to treat multiple cancers, was initially approved in Australia as weight-based dosing at 2 mg/kg every 3 weeks (Q3W). Subsequent approvals used 'fixed' dosages of 200 mg Q3W or 400 mg every 6 weeks (Q6W). Pharmacokinetic equivalence was demonstrated between dosing strategies, with no significant differences in efficacy or toxicity. Fixed dosing regimens are routinely used in Australia. To model and compare the cost of weight-based dosing of pembrolizumab to standard fixed dosing regimens. A single centre, retrospective review was conducted. Patients, identified from dispensing software, who commenced on pembrolizumab between January and December 2022 were included. Patient demographic and treatment data was extracted from electronic medical records. Costs of weight-based doses were calculated and compared to the cost of fixed dosing. Variables such as acquisition cost, funding mechanisms and 'vial sharing' were considered. Fifty-two patients were included (63% male, median age 68 years). Of the 211 doses of pembrolizumab administered (average 4.1 doses/patient), 161 were Q3W doses, and 50 were Q6W doses. The acquisition cost for a fixed 200 mg and 400 mg dose was $7646, and $15,292, respectively. The average patient weight was 77.6 kg (SD 19 kg), which equated to $5933 for a weight-based Q3W dose, and $11,867 for the Q6W dose; a potential cost avoidance of $1965 and $3930 per dose, respectively. This represented a possible 23.5% avoidance in medication acquisition cost. Over the study period of 1 year, using weight-based dosing for pembrolizumab had the potential to reduce medication expenditure by $467,996. Significant cost avoidance could be achieved via weight-based pembrolizumab dosing. Given the substantial total cost of pembrolizumab, the growing number of indications and the expected equivalent treatment outcomes with weight-based pembrolizumab, the potential cost reductions of weight-based pembrolizumab at both institution and government level should be further explored.

Implementation of a Pilot PharmD Medication Optimization Telehealth Clinic Within a Veterans Affairs System.

Background Patients older than 65 years of age with an anticipated life-expectancy of 12 months or less may have complex medication regimens and an increased risk of adverse drug reactions, and drug-drug interactions. Within the Department of Veterans Affairs, a commonly used medication optimization model is known as the VIONE methodology. Objective This project aimed to pilot implementation of board-certified clinical pharmacist practitioners utilizing the VIONE model within a patient-aligned care team targeting patients 65 years of age and older. Methods The population was identified through the VIONE dashboards. Veteran inclusion criteria included five or more medications, a VIONE risk score of 5 or greater, and CAN scores of greater than 90. The project team reached out via telephone to the patients for a medication regimen review and a 14-day follow-up call. Primary outcomes were quantity of medications discontinued per patient, classes of medications that were discontinued, number and encounter time spent, and cost avoidance over 1 year. Secondary outcomes were VIONE classification of medications, VIONE discontinuation reason, number of recommendations given and accepted by primary provider, and safety analysis. Results There were 53 patients who were successfully contacted via telephone. The top four most discontinued medication classes included 1) vitamins/supplements, 2) ophthalmology medications, 3) gastrointestinal medications, and 4) non-controlled analgesic medications. During the project period the potential cost avoidance over 1 year was $17,716. CONCLUSION: This project demonstrated that usage of VIONE methodology ensures medication optimization with minimal harm and provides significant cost savings in the ambulatory care setting.

A population-based assessment of avoidable hospitalizations and resource use of non-vaccinated patients with COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has precipitated a prolonged public health crisis. Numerous public health protections were widely implemented. The availability of effective and safe vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presented an opportunity to resolve this crisis; however, vaccine uptake was slow and inconsistent. This study evaluated the potential for preventable hospitalizations and avoidable resource use among eligible non-vaccinated persons hospitalized for COVID-19 had these persons been vaccinated. This was a retrospective, population-based cohort study. The population-at-risk were persons aged ≥ 12years in Alberta (mid-year 2021 population ~ 4.4 million). The primary exposure was vaccination status. The primary outcome was hospitalization with confirmed SARS-CoV-2, and secondary outcomes included avoidable hospitalizations, avoidable hospital bed-days, and the potential cost avoidance related to COVID-19. The study inception period was 27 September 2021 to 25 January 2022. Data on COVID-19 hospitalizations, vaccination status, health services, and costs were obtained from the Government of Alberta and from the Discharge Abstract Database. Hospitalizations occurred in 3835, 1907, and 481 persons who were non-vaccinated, fully vaccinated, and boosted (risk of hospitalization/100,000 population: 886, 92, and 43), respectively. For non-vaccinated persons compared with fully vaccinated and boosted persons, the risk ratios (95%CI) of hospitalization were 9.7 (7.9-11.8) and 20.6 (17.9-23.6), respectively. For non-vaccinated persons, estimates of avoidable hospitalizations and bed-days used were 3439 and 36,331 if fully vaccinated and 3764 and 40,185 if boosted. Estimates of cost avoidance for non-vaccinated persons were $101.46 million if fully vaccinated and $110.24 million if boosted. Eligible non-vaccinated persons with COVID-19 had tenfold and 21-fold higher risks of hospitalization relative to whether they had been fully vaccinated or boosted, resulting in considerable avoidable hospital bed-days and costs.

The role of clinical trials in the sustainability of the Italian national health service cancer drug expenditure

ObjectiveClinical trials offer new and potentially more effective therapeutic options for cancer patients and a potential cost-saving opportunity, especially considering that trial drugs are provided free-of-charge. The aim of this...

1066: PHARMACY COST AVOIDANCE BY REVIEW OF MEDICAL INTERVENTIONS IN A RESIDENCY PROGRAM: PHARM-RES STUDY

Introduction: Clinical pharmacists play an active role in the interdisciplinary team, such as renally dose adjusting medications and providing antibiotic recommendations, which has a significant impact on patient care. Little is known about the benefit of having pharmacy residents on an independent on-call experience. Pharmacy residents, as extensions of clinical pharmacists, residents at a large academic medical center participate within the multidisciplinary team in the Emergency Department (ED) to provide interventions, which translate into cost avoidance. The purpose of this study was to evaluate the interventions and associated cost avoidance that pharmacy residents provide during ED on-call shifts. Methods: This was a prospective, single-centered, observational study of interventions made by 11 pharmacy residents conducted from October 2021 through May 2022. Pharmacy residents prospectively logged their interventions into a database during their on-call shifts. The primary outcome was the total cost avoidance generated by pharmacy residents from accepted interventions. The secondary outcomes were the quantity and types of interventions, cost avoidance per resident and shift, and cost avoidance to salary ratio. Results: There were 918 interventions accepted on 763 patients over the course of 164 ED resident on-call shifts. The total annualized potential cost avoidance for these interventions was $1,422,474.85. The breakdown of accepted interventions was as follows: adverse drug event prevention 91.0%, resource utilization 64.7%, individualization of patient care 87.2%, prophylaxis 100%, hands-on care 98.3%, and administrative and supportive tasks 94.8%. Among the six categories, the highest potential cost avoidance came from adverse drug event prevention ($420,507.38). The estimated cost avoidance¸ per resident was $129,315.90 and per shift was $5,926.98 with residents intervening on 4 patients on average per shift. The cost avoidance to salary ratio using a pharmacy resident salary was $1.7:1. Conclusions: Interventions made by pharmacy residents during an on-call experience in the ED were associated with significant cost avoidance. Pharmacy residents can provide significant cost avoidance and optimize patient safety as outlined by the interventions and cost avoidance in this study.

Quantifying the Value of the Molecular Tumor Board: Discordance Recommendation Rate and Drug Cost Avoidance.

Molecular tumor boards (MTBs) provide interventions that assist the patient's primary oncologist's interpretation and application of precision oncology and avoid clinical and financial toxicities of prescribing inappropriate targeted therapy. In this article, we describe a novel method for illustrating MTBs value and recommendation discordance rate and report associated drug cost avoidance data. From January 1, 2021, to December 31, 2021, patients assessed by our program's MTB were retrospectively evaluated. Recommendation discordance was defined as any disagreement between MTB therapeutic recommendations and those provided in the next-generation sequencing vendor's report. In 2021, our program processed 1,119 next-generation sequencing orders via external vendors for 1,029 unique patients with a variety of solid tumor and hematologic malignancies. During this period, 962 patients were reviewed through our MTB process. MTB recommendation discordance rate was high (229 of 502; 45.6%) and varied across test vendors. Rationales for discordance included the following: low level of evidence (88% of patients), alternative standard of care available (60%), and tolerability concerns (42%), among others. Discordance was highest for Vendor C (30%), followed by Vendor A (24%) and Vendor B (8%). The most common drug classes not supported were mTOR, PARP, MEK, and PIK3CA inhibitors when recommended by vendors in off-label settings. MTB interventions accounted for $3,209,070 in US dollars in potential drug cost avoidance. Therapeutic recommendation discordance rates can provide quantitative insight into the benefit of MTB. Discordance-associated drug cost avoidance further demonstrates MTB's financial value. These measures may be used as part of the justification for this service line within a cancer care program.

PHarmacist Avoidance or Reductions in Medical Costs in CRITically Ill Adults: PHARM-CRIT Study.

A multicenter, prospective, observational study was performed between August 2018 and January 2019. Community hospitals and academic medical centers in the United States. ICU clinical pharmacists. Recommendations classified into one of 38 intervention categories (divided into six unique sections) associated with cost avoidance. Two-hundred fifteen ICU pharmacists at 85 centers performed 55,926 interventions during 3,148 shifts that were accepted on 27,681 adult patient days and generated $23,404,089 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in six established sections was adverse drug event prevention (5,777 interventions; $5,822,539 CA), resource utilization (12,630 interventions; $4,491,318), individualization of patient care (29,284 interventions; $9,680,036 cost avoidance), prophylaxis (1,639 interventions; $1,414,465 cost avoidance), hands-on care (1,828 interventions; $1,339,621 cost avoidance), and administrative/supportive tasks (4,768 interventions; $656,110 cost avoidance). Mean cost avoidance was $418 per intervention, $845 per patient day, and $7,435 per ICU pharmacist shift. The annualized cost avoidance from an ICU pharmacist is $1,784,302. The potential monetary cost avoidance to pharmacist salary ratio was between $3.3:1 and $9.6:1. Pharmacist involvement in the care of critically ill patients results in significant avoidance of healthcare costs, particularly in the areas of individualization of patient care, adverse drug event prevention, and resource utilization. The potential monetary cost avoidance to pharmacist salary ratio employing an ICU clinical pharmacist is between $3.3:1 and $9.6:1.

The Impact of Telepharmacy Services on the Identification of Medication Discrepancies, High-Alert Medications, and Cost Avoidance at Rural Healthcare Institutions

Telepharmacy, remote reviewing and profiling of medication orders by an offsite pharmacist, has been shown to be an effective method for reducing medication order inaccuracy rates, but there is a lack in studies examining harm reduction and potential cost avoidance by such services. Methods: Retrospective data, collected over a one-year period, were examined for medication order deficiencies; a deficiency was defined as the telepharmacist being required to advocate for clinical action. Based on published rates of adverse drug reactions and expenses related to their treatment, a potential cost avoidance was calculated. Results: Over the course of the one-year study period over 218,000 orders were reviewed by a telepharmacist with 2,292 orders flagged as deficient which included 16,224 individual medication deficiencies. The most common deficiencies included patient allergy to medication, or class of medications, (31.2% of deficiencies) and medication dose adjustment via renal and/or hepatic guidelines (24.1% of deficiencies). There were also a number of deficiencies for specific medications found on the Institute for Safe Medication Practices’ high-alert medication list for ambulatory/community healthcare settings such as insulins and heparinoids. Based on adverse drug reaction incidence rates and treatment expenses, potential cost avoidance was calculated to be as high as over $1.4 million US dollars. Telepharmacists aided in enhancement of pharmacy services by continuing to review medication orders and provide clinical interventions even when an onsite pharmacist was unavailable. Conclusions: Use of the telepharmacist service provided a large cost avoidance by the prevention of potential adverse drug reactions.

Impact of an Interprofessional Collaborative Quality Improvement Initiative to Decrease Inappropriate Thyroid Function Testing.

Background: Published data show that thyroid function laboratory tests are often ordered inappropriately in the acute care setting, which leads to unnecessary costs and inappropriate therapy decisions. Pilot data at our institution indicated that approximately two-thirds of the thyroid-stimulating hormone (TSH) laboratories were unnecessary, correlating to a potential cost avoidance of more than $20,000 annually. The purpose of this study was to improve the appropriateness of thyroid function test ordering with a multipronged initiative. Methodology: This controlled, single-center, before and after study included inpatients or emergency department (ED) patients at Wake Forest Baptist Medical Center who were at least 18 years of age and had a TSH level ordered during the study period. Patients with a history of thyroid cancer were excluded. The initiative included an electronic ordering intervention, direct education of providers (medical residents, attendings, and clinical pharmacists), and distribution of pocket information cards with appropriate ordering criteria. The primary outcome was the number and percentage of inappropriate TSH tests ordered before and after implementing the 3 interventions. Secondary outcomes included cost savings, inappropriate changes in thyroid therapy based on improperly ordered tests, and the number of free T4 lab tests ordered on patients with a TSH within the therapeutic range. Results: All 3 interventions were implemented, except for education of ED residents and faculty, who chose to forgo the direct education component. Inappropriate ordering of TSH levels decreased from 63 to 50 (13% reduction, P = .062) after implementation. Inappropriate TSH ordering decreased across all services, except in the ED. Inappropriate Free T4 orders decreased from 191 to 133 (30% reduction, P = .01). There were no therapy changes based on inappropriate TSH orders. Extrapolated annual cost savings were approximately $6,000. Conclusion: This multipronged interprofessional collaborative quality improvement initiative was associated with a nonstatistically significant reduction in inappropriate TSH orders, statistically significant reduction in inappropriate free T4 orders, and cost savings. There was a reduction in inappropriate ordering across all services except the ED, which may have been due the ED not participating in the direct education component of the initiative.

PMD15 ASSESSMENT OF THE RISK AND ECONOMIC BURDEN OF SURGICAL SITE INFECTION FOLLOWING COLORECTAL SURGERY USING A US LONGITUDINAL DATABASE: IS THERE A ROLE FOR INNOVATIVE ANTIMICROBIAL WOUND CLOSURE TECHNOLOGY TO REDUCE THE RISK OF INFECTION?

Colorectal surgical procedures place substantial burden on healthcare systems because of the high complication risk, especially surgical site infections. The purpose of this study was to determine the incidence and true cost of infections after colorectal surgery and potential economic impact of using antimicrobial wound closure to improve patient outcomes. This was a retrospective observational cohort analysis and probabilistic cost analysis, using the IBM® MarketScan® Commercial and Medicare Claims database. A total of 107,665 patients undergoing colorectal surgery between 2014 and 2018 in the United States were identified. Rate of infection was identified between 3-180 days postoperatively. Logistic models were used to evaluate risk for infection and generalized linear models were developed to estimate 2018 inflation-adjusted payer cost of infection within 24 months post surgery. Potential cost avoidance from avoided infections using antimicrobial sutures were further estimated using a probabilistic decision-tree using Monte Carlo simulation. Post-operative infections were diagnosed in 23.9% of patients (4.0% superficial incisional (SS) and 19.9% deep incisional/organ-space (DIOS)). Risk factors for DIOS infections included obesity, and admission type (emergency vs elective) among others. After 12-months, payer costs associated with superficial incisional and deep incisional/organ-space infections averaged $36,196 (9% confidence interval (CI): 32,840-39,691) and $77,043 (95%CI: $75,179-$78,941) for Commercial payers and $17,323 (95% CI: $12,805-$22,191) and $55,089 (95%CI: $52,340-$57,940) for Medicare, respectively. Use of antimicrobial suture wound closure for colorectal surgery was estimated to reduce mean payer costs by $1,435-$2,405 per patient compared with traditional wound closure. Infection cost burden was found to be higher than previously reported, with payer costs increasing over a 24-month postoperative period. Findings in this study were estimated using modeling techniques with inherent limitations, however, results suggest overall savings from use of antimicrobial sutures as a component of a comprehensive evidence-based surgical care bundle for reducing infection risk.

PDG1 ECONOMIC AND CLINICAL BENEFITS OF STATIN USE PRIOR TO INTENSIVE CARE UNIT (ICU) ADMISSION: A PROPENSITY SCORES MATCHING APPROACH

In addition to cholesterol lowering properties, statins (hydroxymethyl glutaryl coenzyme-A reductase inhibitors) have anti-inflammatory and pleiotropic effects in infection which may result in clinical and economic benefits. Pleiotropic effects of statins are controversial, and evidence is limited among the ICU population. This study seeks to understand the impact of pre-ICU statin use on sepsis-related mortality and length of stay (LOS) in days. This study is a single-center retrospective cohort study of sepsis patients admitted to a major tertiary referral hospital ICU from 2002 to 2012. Pre-ICU statin users were matched to non-statin users using greedy 1:1 propensity score matching technique. Multivariate logistic regression and negative binomial regression were used to estimate odds ratios and natural log of LOS, respectively. Avoided costs due to reduced LOS was determined by estimating the product of the (i) percentage LOS reduction, (ii) average LOS and (iii) average cost of ICU stay pay day. Sensitivity analysis was performed using inverse probability of treatment weighting using the propensity score. A total of 10,129 eligible sepsis patients were identified, and a matched population of statin users (n=1,470) and non-statin users (n=1,470) were obtained. Most patients were white (75.7%) and aged 80 years and above (54.8 %). After adjusting for covariates, pre-ICU statin use was associated with lower odds of ICU-related mortality compared to non-statin use (aOR 0.81; 95% CI: 0.68 – 0.96). After adjusting for other covariates, pre-ICU statin use was associated with shorter LOS by 24% (Coefficient: -0.1272; 95% CI: -0.1996, -0.0549) compared to non-statin users, resulting in a potential cost avoidance of $5,381 per ICU admission per patient Among sepsis patients, pre-ICU statin use was associated with lower odds of mortality resulting in potential cost avoidance of $5,381 per ICU admission.

Implementing a Nurse Discharge Navigator: Reducing 30-Day Readmissions for Heart Failure and Sepsis Populations.

The purpose of this quality improvement project was to evaluate the impact of a nurse discharge navigator on reducing 30-day readmissions for the heart failure and sepsis populations. The 238-bed community hospital in central Virginia is part of a health care system that encompasses 13 acute care facilities. The aim of this project was to identify, implement, and evaluate the transition of care of high-risk readmission patients from January 2019 to April 2019. Inclusion criteria included patients who were 55 years and older, English speaking, diagnosed with heart failure and/or sepsis, discharged to home with or without home health, and/or consults received from case management and social services. Forty-one potential participants were identified with 28 consented. Readmission data were collected pre- and postintervention. The pre-/postanalysis consisted of descriptive statistics, readmission rates, and cost avoidance. Out of the 28 participants, 7 participants were readmitted within 30 days. The heart failure readmission rates during the project implementation were as follows: January 24.05%, February 20%, March 19.75%, and April 11.11%. After the project completion the readmission rates were 22.97% for May and 26.03% for June, respectively. The potential cost avoidance with sustained gain from the project is $405,316.00. This project demonstrated that a discharge navigator had an effect on 30-day readmissions for high-risk heart failure and sepsis populations, as evident by a steady decline in overall heart failure readmission rate during project implementation. The sepsis population needs further research. The discharge navigator project added to the body of knowledge for comprehensive discharge planning, coordination, and education that is needed for these types of patient populations that have a great deal of medical complexity.

51 Evaluation of a Clinical Pharmacy Service on an Inpatient Ward in an Acute Hospital

Abstract Background Intensive clinical pharmacy input from admission to discharge has been shown to improve patient outcomes. The clinical pharmacy service in our institution has historically been under-resourced. The aim of this study is to develop a ward-based clinical pharmacy service and to evaluate its impact using a number of clinical, safety and financial metrics. Methods A clinical pharmacist was assigned to provide pharmaceutical care to patients on a Medicine for the Older Person ward. Over an eight week period, the pharmacist prospectively recorded her interventions/activities. To assess impact on patient care, interventions were graded according to the Eadon criteria. The potential cost avoidance associated with interventions was estimated. Medication incident reporting was analysed to assess the impact on patient safety. Results 87% of patients had at least one pharmacist intervention, across a spectrum of activities including medication reconciliation and clinical review. 90% of interventions requiring follow-up with the medical team were accepted and resulted in a change to patient’s care. Eadon grading of interventions deemed 99% to be significant, with 81% improving the standard of patient care. Two different methods were used to estimate potential cost avoidance: one estimated annual savings of €154,103 - €344,926; the other estimated these at €174,373. Given current pharmacist salary costs, this equates to a cost-benefit ratio of 2.8:1 to 6.3:1. (This does not include the 27% reduction in drug spend observed during the study period. However, more longitudinal data are required to confirm and characterise this phenomenon.) A five-fold increase in medication incident reporting from the ward was observed, suggestive of an enhanced culture of patient safety. Conclusion This study assessed and quantified a wide spectrum of pharmacist contributions to medication management and safety. Costing of these contributions estimates the cost-benefit ratio of the clinical pharmacy service, providing compelling support for the extension of this service throughout the hospital.

P059 Potential cost avoidance benefits of the early identification of and differentiation Between IBD and IBS

BACKGROUND: Changes in distribution and composition of microbiome species may be associated with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). IBD, which includes ulcerative colitis (UC) and Crohn's disease (CD) is an immune-mediated inflammatory disease. IBS is a chronic functional disease characterized by a series of symptoms such as cramping, diarrhea, and constipation. There are specific medications for IBD used to treat the underlying disease and keep it in remission, whereas IBS is more commonly addressed by treating the symptoms and adjusting one's lifestyle to avoid triggers of the condition. Thus, distinguishing between these 2 conditions is important. To address this need uBiome® has developed SmartGutTM, a sequencing-based clinical microbial test that can detect beneficial and pathogenic microorganisms associated with IBS and IBD and help distinguish between these conditions. In this study we developed a model to estimate the cost impact of using SmartGutTM in a US population of patients with gastrointestinal distress. METHODS: A model was developed from the perspective of a US payer that provides SmartGutTM as a screening tool for beneficiaries. The model estimates the incidence of gastrointestinal distress from the combined incidence rates of IBD, IBS, and other causes. Utilization was informed by manufacturer patient analysis. The cost of SmartGutTM was based on test costs from the manufacturer. RESULTS: For a hypothetical US payer covering 1,000,000 lives, the annual incidence of patients with chronic gastrointestinal distress is estimated to be 68,820 215,820, of which 27% are expected to receive repeat testing with an average of 2.35 SmartGutTM screenings per patient for a total of 93,905 annual screenings. This costs the plan $48,318,761 annually, equating to an additional $4.03 per member per month compared to usual care. However, the SmartGutTM test report details the presence and quantity of microorganisms associated with IBS and IBD. The report includes recommendations for healthcare providers on treatment, lifestyle, and diet that can be discussed with the patient. Testing in these patients may lead to earlier identification of IBS or IBD, which may result in improved downstream outcomes and more efficient use of healthcare resources. Further research is being conducted in order to clearly delineate the test specifications of IBS and IBD as well as downstream health outcomes. CONCLUSION(S): Here we present our initial investigations to estimate the cost avoidance benefits of the early identification of and differentiation between inflammatory bowel disease and irritable bowel syndrome using SmartGutTM in a US population of patients, highlighting test costs and improved outcomes.

Opioid prescribing upon discharge for patients with solid malignancies.

50 Background: Pain is a common symptom associated with cancer resulting in increased health care utilization. We aim to study patients admitted with uncontrolled pain and review their discharge medications after development of an effective pain regimen while hospitalized. Anecdotally, we observe patients are being discharged with suboptimal regimens resulting in increased Emergency Department (ED) visits or readmissions. By identifying suboptimal opioid prescriptions we hope to improve care and patient satisfaction and minimize ED visits or readmission rates. The primary objective is to identify opportunities for improvement of opioid prescribing upon discharge for medical oncology patients. Methods: Retrospective study exempt from IRB review. We reviewed admitted patients with a solid tumor cancer diagnosis and consult to inpatient medical oncology at a safety-net hospital in an urban Southeastern population from June to November 2017 with data collected on 29 patients. Data was analyzed using descriptive statistics. Potential health-system cost avoidance was calculated. Results: 51% of patients were discharged with a lower daily oral morphine equivalent (DOME) than received while inpatient, with a median of 12 days until scheduled follow-up appointment. While 75% of patients were prescribed an adequate supply for long acting opioids, only 39% received an adequate supply of short acting opioids. 12 patients (41%) returned to the ED or urgent clinic within 30 days. 4 events were associated with a lower DOME and/or inadequate supply compared to their inpatient regimen. The total amount billed for missed opportunities showed the hospital was reimbursed only 25%. Conclusions: Opportunities to prevent discrepancies in discharge regimens exist. Pain regimens should be assessed for accuracy and supply at discharge and appointments. Patients should be discharged with a sufficient amount of opioids until their follow up, including ensuring insurance coverage of medication prescribed, with emphasis on patients maintaining their outpatient appointments. We plan to continue analysis post continuous QI initiative to improve clinical practice in pain management for patients with solid tumor malignancy.

Potential Cost Avoidance Benefits of the Early Identification of and Differentiation Between Inflammatory Bowel Disease and Irritable Bowel Syndrome

Introduction: Changes in composition of microbiome species may be associated with inflammatory bowel disease (IBD) or irritable bowel syndrome (IBS). IBD, which includes ulcerative colitis (UC) and Crohn's disease (CD) is an immune-mediated inflammatory disease whereas IBS is a chronic functional disease characterized by symptoms such as cramping, diarrhea, and constipation. Medications are used for IBD to treat the underlying disease and keep it in remission. IBS is more commonly addressed by symptom treatment and lifestyle adjustments. Thus, distinguishing between these two conditions is important. To address this need, uBiome® has developed SmartGutTM, a sequencing-based clinical microbial test that can detect beneficial and pathogenic microorganisms associated with IBS and IBD. In this study we developed a model to estimate the cost impact of using SmartGutTM in a US population of patients with gastrointestinal distress. Methods: A model was developed from a US payer perspective that provides SmartGutTM as a screening tool. The model estimates the incidence of gastrointestinal distress from the combined incidence rates of IBD, IBS, and other causes. Utilization was informed by manufacturer patient analysis. The cost of SmartGutTM was based on test costs from the manufacturer. Results: For a US payer covering 1,000,000 lives, the annual incidence of patients with chronic gastrointestinal distress is estimated to be 215,820, of which 27% are expected to receive repeat testing [uEB1] with an average of 2.35 screenings /patient. This costs the plan $151,527,972 annually, equating to an additional $12.63 per member per month compared to usual care. However, the SmartGutTM test report details the presence of microorganisms associated with IBS and IBD. The report includes recommendations for healthcare providers on treatment, lifestyle, and diet that can be discussed with the patient. Testing in these patients may lead to earlier identification of IBS or IBD, which may result in improved downstream outcomes and more efficient use of healthcare resources. Further research is being conducted in order to clearly delineate the test specifications of IBS and IBD and downstream health outcomes. Conclusion: Here we present our initial investigations to estimate the cost avoidance benefits of the early identification of and differentiation between IBD and IBS using SmartGutTM in a US population of patients, highlighting test costs and improved outcomes.

Financial Impact of PEVAR Compared With Standard Endovascular Repair in Canadian Hospitals

ObjectivesThe percutaneous endovascular abdominal aortic repair (PEVAR) approach is a minimally invasive technique that has demonstrated clinical benefit over traditional surgical cut down associated with standard endovascular abdominal aortic aneurysm (AAA) repair (EVAR). The objective of our study was to evaluate the budget impact to a Canadian hospital of changing the technique for AAA repair from the EVAR approach to the PEVAR approach. MethodsWe examined the budget impact of replacing the EVAR approach with the PEVAR approach in a Canadian hospital that performs 100 endovascular AAA repairs annually. The model incorporates the costs associated with surgery, length of stay, and postoperative complications occurring within 30 days. ResultsThe use of PEVAR in AAA repair is associated with increased access device costs when compared with the EVAR approach (CAD$1000 vs CAD$400). However, AAA repair completed with the PEVAR approach demonstrates reduced operating time (101 minutes vs 133 minutes), length of stay (2.2 days vs 3.5 days), time in the recovery room (174 minutes vs 193 minutes), and postoperative complications (6% vs 30%), which offset the increased device costs. The model establishes that switching to the PEVAR approach in a Canadian hospital performing 100 AAA repairs annually would result in a potential cost avoidance of CAD$245,120. ConclusionsA change in AAA repair technique from EVAR to PEVAR can be a cost-effective solution for Canadian hospitals.

Potential Cost Avoidance of Adverse Drug Reactions Prevention in Outpatient Pharmacy Department Ramathibodi Hospital Thailand

Pharmacists’ intervention in hospital setting is very beneficial both in patients’ clinical outcomeand economic aspect, in terms of cost avoidance due to adverse drug reactions. This study was conductedto calculate cost avoidance of adverse drug reactions (ADR) prevention in outpatient pharmacydepartment in Ramathibodi Hospital Thailand. A retrospective database review of hospital pharmacyinterventions preventing adverse drug reaction was conducted at second floor pharmacy unit, Somdech-PhraDebaratana Medical Center, Ramathibodi hospital between 1 July 2013 and 31 December 2013. Potentialcost avoidance of ADR was calculated using diagnosis-related groups (DRG’s) data. Results showedthat the detection of ADR was 0.239%. The most frequent ADR came from Penicillin group was accountedfor 32.4% of total case. The estimated cost avoidance generated during July-December 2013 was ThaiBaht (THB) 592,320 to THB 1,257,428 (USD 19,278 to USD 40,925, value 2013). It can be concludedthat hospital pharmacists positively impacted on economic benefit of patients by providing ADR detection.More complete data are needed to get a better results of a real cost avoidance of ADR prevention.

Abstract 12565: Transitional Care Model Decreases Readmission in the Left Ventricular Assist Device Patients

Decreasing 30-day readmission rates is critical to minimizing penalties from Medicare and Medicaid. Hospital readmission rates in the Left Ventricular Assist Device (LVAD) programs are 26% to 76% and are highly contingent on successful transitions to home. A Transitional Care Model (TCM) approach is comprehensive, holistic and involves collaboration between the patient and their caregiver. The efforts guided by the TCM, in managing symptoms, education of self-management, coordinating care, and maintaining relationships, are patient and caregiver focused. The principles of the TCM involve patient screening to evaluate for their risk for readmission. The purpose of this pilot study is to evaluate the effectiveness of an intervention based on the TCM in reducing readmission rate. This pilot of the TCM was conducted at a single major medical center which places approximately 60 LVADs yearly. A total of ten participants were enrolled using convenience sampling between June and August of 2015. The eight-week program consisted of an individualized self-management care plan and a combination of weekly follow-up home visits or phone calls. Medical records were reviewed in addition to obtaining participant satisfaction surveys. Pilot evaluation is based on the 30-day readmission rate, participant satisfaction, and program costs. Of the ten participants, six completed the program. The 30-day readmission rate for the six was 16.7%, as compared to the hospital’s readmission rate of non-enrolled participants at 32.1%. The participants expressed overall satisfaction with the program and would willingly use the program if needed; they also said they would recommend the program to family and friends. The total program costs were estimated at $125,444. The cost of readmission at the 32.1% rate and 16.7% are $674,100 and $350,700 respectfully; with a potential cost avoidance of the TCM program of $248,356. Patients with an LVAD experience compounding stressors of managing a chronic illness, an acute surgical intervention, and a life-sustaining device. The TCM pilot was able to achieve successful outcomes in the midst of these stressors. Further inquiry in interventions consistent with TCM is needed to advance care and transitions in the LVAD patient population.

Evaluation of the dosing strategies of biologic agents and the theoretical impact of dose rounding.

Introduction Monoclonal antibodies possess unique pharmacokinetic properties that permit flexible dosing. Increased use and high costs of these medications have led to the development of cost-containing strategies. This study aims to quantify the cost savings and clinical impact associated with dose rounding monoclonal antibodies to the nearest vial size. Methods This study was a single-arm, retrospective chart review assessing all monoclonal antibody doses dispensed at an outpatient community infusion center associated with an academic medical center between August 2014 and August 2015. All monoclonal antibody doses were reviewed to determine the cost of drug wasted using two methods. The waste-cost analysis described the amount of drug disposed of due to the use of partial vials. The theoretical dose savings described potential cost avoidance based on rounding the ordered dose to the nearest vial size. The theoretical rounded dose was compared to the actual ordered dose to explore clinical implications. Results A total of 436 doses were included. Of these, 237 were not rounded to the nearest vial size and included in the analysis. The cost of waste associated with these doses was $108,013.64 using actual wholesale price. The potential cost avoidance associated with the theoretical dose calculation was $83,595.53. Rounding these doses to the nearest vial size resulted in a median 6.7% (range, 1.4-20%) deviation from ordered dose. Conclusions Rounding monoclonal antibodies to the nearest vial size could lead to significant cost and waste savings with minimal deviation from the actual ordered dose.