Total Cost Avoidance Research Articles

The Business Case for Simulation-based Hospital Design Testing; $90M Saved in Costs Avoided

Introduction: Simulation-based hospital design testing (SbHDT) applied during the design of a healthcare facility ensures that the architectural design supports safe, high-quality, and efficient care delivery beyond applicable building code compliance. This prospective investigation assesses the financial impact of SbHDT in the form of cost avoidance. Methods: In designing a new free-standing 400+ bed children’s hospital, SbHDT identified latent conditions early in the planning process to mitigate safety concerns related to the proposed design of 15 clinical areas. Architectural modifications were made to address concerns and resolve latent conditions before construction. The estimated cost of materials and labor to make an architectural change was documented for each architectural modification. Unit cost multiplied by unit count for each design element changed was summed together as total cost avoidance. Results: The cost to conduct the simulation was $1.6M (0.01% of overall project cost). Seven hundred twenty-two latent conditions were identified, and 57% of those latent conditions were mitigated by design changes. Ninety million dollars in costs were avoided by making design modifications before construction. Twenty-eight percent of latent conditions (n = 117) would have been cost-prohibitive to modify after construction. Conclusions: SbHDT harnessed evidence-based design to improve clinical care, optimize safety, and maximize investment. SbHDT was financially practical and had a significant impact on cost avoidance. Implementing SbHDT is associated with upfront costs, but long-term savings will accumulate over time through expenses avoided through mitigation of safety threats and operational savings.

Financial impact of integrated specialty pharmacy efforts to avoid oral anticancer medication waste.

The growing number of oral anticancer medications represents a significant portion of pharmacy spending and can be costly for patients. Patients taking oral anticancer medications may experience frequent treatment changes following necessary safety and effectiveness monitoring, often resulting in medication waste. Strategies to avoid medication waste could alleviate the financial burden of these costly therapies on the payer and the patient. To evaluate the impact on waste and cost avoidance of reviewing the amount of medication patients have on hand and the presence of upcoming follow-up (ie, provider visit, laboratory testing, or imaging) before requesting a prescription refill renewal for patients taking oral anticancer medications through an integrated health system specialty pharmacy. We performed a retrospective review of patients filling oral anticancer medications prescribed by a Vanderbilt University Medical Center provider and dispensed by Vanderbilt Specialty Pharmacy between January 1, 2020, and December 31, 2020. Specialty pharmacists received a system-generated refill renewal request for oral anticancer medications when the final prescription refill was dispensed, prompting the pharmacist to review the patient's medical record for continued therapy appropriateness and to request a new prescription. If the patient had a sufficient supply on hand to last until an upcoming follow-up (ie, provider visit, imaging, or laboratory assessment), the pharmacist postponed the renewal until after the scheduled follow-up. Patients were included in the analysis if the refill renewal request was postponed after review of the amount of medication on hand and the presence of an upcoming follow-up. Medication outcomes (ie, continued, dose changed, held, medication changed to a different oral anticancer medication, or discontinued) resulting from the follow-up were collected. Cost avoidance in US dollars was assigned based on the outcome of follow-up by calculating the price per unit times the number of units that would have been unused or in excess of what was needed if the medication had been dispensed before the scheduled follow-up. The average wholesale price minus 20% (AWP-20%) and wholesale acquisition cost (WAC) were used to report a range of costs avoided over 12 months. The total cost avoidance over 12 months associated with postponing refill renewal requests in a large academic health system with an integrated specialty pharmacy ranged from $549,187.03 using WAC pricing to $751,994.99 using AWP-20% pricing, with a median cost avoidance per fill of $366.04 (WAC) to $1,931.18 (AWP-20%). Refill renewal requests were postponed in 159 instances for 135 unique patients. After follow-up, medications were continued unchanged in only 2% of postponed renewals, 56% of follow-ups resulted in medication discontinuations, 32% in dose changes, 5% in medication changes, and 5% in medication holds. Integrated health system specialty pharmacist postponement of refill requests after review of the amount of medication on hand and upcoming follow-up proved effective in avoiding waste and unnecessary medication costs in patients treated with oral anticancer medications at a large academic health system.

Cost-benefit analysis with return on investment of clinical pharmacists in the Military Health System.

The Defense Health Agency comprises more than 700 military medical, dental, and veterinary facilities and provides care to more than 9.6 million beneficiaries. As medication experts, pharmacists identify opportunities to optimize medication therapy, reduce cost, and increase readiness to support the Defense Health Agency's mission. The Tripler Pilot Project and the Army Polypharmacy Program were used to establish a staffing model of 1 clinical pharmacist for every 6,500 enrolled beneficiaries. No large-scale cost-benefit study within the military health care system has been done, which documents the number of clinical interventions and uses established cost-avoidance (CA) data, to determine the cost-benefit and return on investment (ROI) for clinical pharmacists working in the medical treatment facilities. To validate the patient-centered medical home staffing model across the military health care system using the Tripler Pilot Project results to provide a cost-benefit analysis with an ROI. The secondary goal is to describe the interventions, staffing levels, and US Department of Defense-specific requirements impacting the provision of clinical pharmacy. A retrospective analysis of 3 years of encounters by clinical pharmacists in which an intervention was documented in the Tri-Service Workflow (TSWF) form as part of the electronic health record was completed. The analysis used 6 steps to assign CA intervention types and to prevent duplication and overestimation of the ROI. The absolute number of clinical pharmacists was determined using workload criteria defined as at least 20 encounters per month for at least 3 months of each calendar year. The number of clinical pharmacist full-time employees (FTEs) was determined by dividing the number of total active months by 12 months. Attrition was calculated comparing the presence of a unique provider identification between calendar years. The ROI range was calculated by dividing the CA by the total cost of clinical pharmacists using the variables' raw and extrapolated CA based on percentage of documentation template usage and the active clinical pharmacist calculation (absolute and FTE-based). Between January 1, 2017, and December 31, 2019, a total of 1,069,846 encounters by clinical pharmacists were documented in the electronic health record. The TSWF Alternative Input Method form was used by pharmacists to document 616,942 encounters. Forty-three percent of TSWF documented encounters had at least 1 CA intervention. The absolute number of clinical pharmacists associated with a documented encounter in any medical treatment facility ranged from 404 in 2017 to 374 in 2018 and the clinical pharmacist FTEs ranged from 324 in 2017 to 314 in 2019. Annual attrition rates for clinical pharmacists ranged from 15% to 20% (58 to 81 clinical pharmacists) annually. The total CA range was $329,166,543-$534,014,494. The ROI range was between $2 and $4 per dollar spent. This analysis demonstrated that ambulatory care clinical pharmacists in the Military Health System bring value through a positive ROI. Our study also identified a potential shortage of clinical pharmacists within the Air Force and Navy branches impacting medication management. This can have a negative impact on the readiness of service members, one of the leading priorities of the US Department of Defense.

Prevented harm and cost avoidance with pharmacist intervention while utilizing a discharge medication reconciliation tool.

The aim of this study was to determine prevented harm and cost avoidance following pharmacist intervention utilizing a discharge medication reconciliation tool. A retrospective chart review was conducted to identify patients with pharmacist-initiated, provider-accepted discharge medication reconciliation interventions completed at a community teaching hospital in January 2021. Investigators assigned the discrepancies targeted for intervention a National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) category, probability of harm, and calculated cost avoidance. The primary endpoint was the total cost avoidance associated with discharge medication reconciliation. Pharmacists intervened 190 times in January 2021, avoiding an estimated $46,958 to $231,032 in cost. High-risk medications were associated with $33,920 to $147,203 in cost avoidance. The 3 high-risk therapeutic classes associated with the highest cost avoidance were insulin ($16,738-$70,793), antithrombotics ($13,884-$60,016), and opioids ($2,638-$11,834). Targeted pharmacist discharge medication reconciliation and related interventions avoid significant cost and patient harm.

Clinical and economic impact of oncology-trained pharmacist integration in an ambulatory cancer clinic.

Outpatient oncology practice is a growing area of opportunity for pharmacists to provide clinical services and evidence-based care. This single-center, retrospective chart review analyzed the clinical and economic benefits of a board-certified oncology pharmacist after integration into the ambulatory oncology clinic setting. Primary outcomes were total cost avoidance for pharmacist interventions and impact on Centers for Medicare and Medicaid Services (CMS) OP-35 measures. Pharmacist interventions were characterized into distinct types which were then assigned a cost avoidance value. Cost avoidance was calculated per hour and then extrapolated to a yearly estimate based on a 40-h work week for one year for one full-time equivalent pharmacist. Data collection for the primary clinical outcome was performed by compiling provider-specific emergency department (ED) and inpatient admission rates for diagnoses specified in CMS OP-35 measures within 30 days after receiving outpatient chemotherapy. The rates for the data collection period were compared to the rates six months prior to pharmacist integration to assess pharmacist impact. In six months, 516 total interventions were made by the oncology pharmacist. The incidence of ED visits was 3.34% and 1.72% during the pre- and post-pharmacist intervention periods, respectively. The incidence of inpatient admissions was 2.43% and 0.34% pre- and post-pharmacist intervention, respectively. Total cost avoidance was estimated to be US$375,795 and when accounted for the median pharmacist salary at our institution, total cost savings was US$204,437. The presence of an oncology pharmacist specialist in the ambulatory cancer clinic provided clinical and economic benefits to the cancer clinic.

Cost savings and cost avoidance with the inpatient clinical pharmacist interventions in a tertiary cancer care hospital.

The economic benefit of the clinical pharmacist's role in ensuring the optimum use of medicines is potentially considerable, particularly when it comes to cancer management. We sought to evaluate the overall economic impact of clinical pharmacist interventions in the main cancer setting in Qatar. The total economic benefit of the clinical pharmacy interventions were analyzed from the public hospital perspective. Patient records in March 2018, July/August 2018, and January 2019 were retrospectively reviewed at the National Center for Cancer Care and Research, Qatar. The total benefit from interventions was the total cost avoidance due to preventable adverse drug events plus any cost savings associated with therapeutic-based resource use. Sensitivity analyses confirmed the results' robustness and increased generalizability. A total of 1352 interventions based on 281 patients were analyzed. The majority of the drug-related problems were related to the appropriateness of therapy, followed by dosing and administration. The total population benefit over the 3-months study period was QAR 4,879,185 (USD 1,336,763), constituting cost avoidance of QAR 4,234,012 (USD 1,160,003) and negative resource-use cost savings of -QAR 645,174 (-USD 176,760). Projected annual overall benefit was QAR 14,355,354 (USD 3,932,974). The increase in resource use with therapies was mostly because of the addition of other medications. Cost avoidance was mostly driven by recommending additional medications and discontinuation of medications. The uncertainty analysis demonstrated the robustness of outcomes. The clinical pharmacist intervention increased resource use and its cost. In overall, however, taking avoided cost of adverse drug events in consideration, it is an economically beneficial practice in the National Center for Cancer Care and Research setting, associated with adverse drug events prevention and substantial economic benefits.

Nurses in a SNAP: Increasing Self-Confidence for Competent Nursing Practice through a Student Nurse Employment Model

Background Although self-confidence is strongly correlated with safe patient care, there is limited research about self-confidence perceptions among new graduate nurses upon entry into licensed practice. This study evaluated the effect of the Student Nurse Apprenticeship Program’s (SNAP) three-tiered employment model on new graduate registered nurse (RN) self-confidence and the organization’s subsequent return on investment. Objective Evaluate the effect of a pre-licensure, student nurse employment model on licensed nurses in three areas: perceived self-confidence related to patient safety, new graduate nurse orientation length, and organizational RN retention. Method A quasi-experimental, nonequivalent control group posttest study was conducted at Norton Healthcare (NHC) with SNAP Cohort One. Graduate RNs who completed SNAP and a control group of non-SNAP new graduate RNs took the Health Professional Education in Patient Safety Survey tool prior to starting NHC new graduate nurse orientation. During SNAP application, applicants completed the Human Systems Integration tool which aids in assessment of the relationship between the individual and the role’s responsibilities. Results In SNAP Cohort One, statistically significant (p < 0.05) increases in perceived self-confidence related to patient safety were found in SNAP graduates. Organizational retention was captured at 90% from SNAP to NHC RN, a 94% one-year RN retention, and a 96% two-year RN retention. The mean new graduate RN orientation length for SNAP graduates decreased three weeks. Total organizational cost avoidance of $8.5 million was shown in decreased orientation time and first year RN retention. Conclusions This study shows that the new graduate RNs completing SNAP had higher perceived self-confidence related to patient safety compared to new graduate RNs who did not complete SNAP. With the success of SNAP Cohort One, in conjunction with the strong return on NHC’s financial investment and creation of a workforce pipeline, NHC continued the program. After five successful cohorts and 696 student nurses, SNAP graduates avoided the organization over $33 million in first year RN turnover costs. SNAP graduate to NHC RN retention remained at 90%, with first year RN retention at 92%, and second year RN retention at 84%. The mean decrease in orientation time for all five cohorts remained between two and three weeks.

1016: IMPACT OF PROSPECTIVE PHARMACIST REVIEW DURING INTENSIVE CARE UNIT TO FLOOR TRANSFER

Introduction: Recent studies have shown that almost half of ICU to floor transfers resulted in at least one medication related error. To our knowledge, prospective pharmacist review within 24 hours of ICU to floor transfer has not been evaluated as an intervention to decrease the risk of medication related errors. The primary objective of this study was to evaluate the impact of prospective pharmacist review following ICU to floor transfer. Methods: This was a two-phase pilot study conducted at Temple University Hospital. The first phase was a prospective medication profile review within 24h of ICU to floor transfer. Phase two was a retrospective analysis evaluating ICU readmission within 7 days. Patients being transferred between 12/11/2021 and 03/04/2022 were included if they met the following criteria: age > 18 years of age, ICU length of stay > 48 hours, and transferred from an ICU to a medical/surgical ward. Secondary endpoints included: types of errors, medication classes involved, cost avoidance, and ICU readmission within 7 days of transfer. Severity of errors were classified by the Overhage and Lukes scale. Descriptive statistics were used to analyze the data. Results: During the 51-day study period, 107 patients were included. Twenty-three patients had a SOFA score > 6 and most patients were transferred from the medical respiratory ICU (n=36). The total number of medication errors identified was 188. There were no Grade A errors and the most common error severity was Grade C (n=33) and E (n=34). The most common type of error was ‘appropriate therapy’ with ‘No indication’ as the most common type of inappropriate therapy. The total cost avoidance was $35,588 over 51 days and the mean time spent per patient was 30 minutes. One patient was readmitted to the ICU within 7 days. Conclusions: Although most errors were Grade C or E, if not caught early, may have resulted in a more severe error. By providing this clinical service at our institution, we estimate an annual cost avoidance of over $250,000 per year. Given our patient population had a lower severity of illness, this value may be higher in a more severely ill population. This study is hypothesis generating, but could justify a full-time clinical pharmacist with a focus on ICU transitions of care.

896. Cost-Avoidance Associated with Active Stewardship of Remdesivir

Abstract Background The COVID pandemic shifted antimicrobial stewardship resources at community hospitals. One reason for this shift was new COVID treatments, the first of which was remdesivir, which received initial emergency use authorization (EUA) for the treatment of COVID-19 in May 2020. The UNC Health Southeastern (UNC SEH) pharmacy director stewarded remdesivir by reviewing patients to ensure they met emergency use authorization (EUA) and guideline-based appropriateness criteria. The infectious diseases physician resolved any disputes regarding patient candidacy for remdesivir. The goal of remdesivir stewardship was to optimize care; however, the shift in workflow presented an unrecognized opportunity for stewards to reduce remdesivir costs. Methods The percentage of COVID patient admissions receiving remdesivir at UNC SEH for calendar years 2020 and 2021 was benchmarked against 32 community hospitals in the Duke Antimicrobial Stewardship Outreach Network (DASON) (Figure 1). UNC SEH purchasing data were used to calculate remdesivir expenditures for 2020 and 2021. Next, the anticipated cost if the hospital had prescribed remdesivir to the same percentage of admissions as the DASON mean was calculated. The difference was calculated to determine the cost avoidance achieved by having below average use of remdesivir (Table 1). Results At UNC SEH, 28.1% of COVID admissions received remdesivir in 2020 and annual remdesivir expenditures were $693,680. In 2021, 47.45% of COVID-19 admissions received remdesivir and drug expenditures were $1,248,000. The DASON mean % of COVID admissions receiving remdesivir in 2020 was 44.08% and 60.07% in 2021. A total cost avoidance of $726,407 was calculated based on the hospital’s below-benchmark use of remdesivir (Table 1). Conclusion UNC SEH achieved significant cost-savings in 2020 and 2021 due to active remdesivir stewardship. The team created a patient-centered model that focused on using drugs for the right patients and the organization realized cost-savings while ensuring that patients received therapy in accordance with remdesivir EUAs and published guidelines. Disclosures All Authors: No reported disclosures.

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.

Description and financial impact of ambulatory care pharmacy team interventions within an underserved patient population.

The purpose of this study was to characterize and quantify the types of interventions made by an ambulatory care pharmacy team (ACPT), evaluate the financial impact of such interventions, and create a cost template for the interventions using the health system's intervention documentation system. We conducted a retrospective, single-center cohort study covering the period from July 1, 2018, to June 30, 2020. Eligible participants included patients aged 18 years or older who had an appointment at the ambulatory care clinic and received a pharmacy consult. Most patients were uninsured. Data collected included intervention types, specific interventions, the economic impact per intervention, the average cost avoidance per intervention, the total economic impact, and the total cost avoidance. The ACPT documented a total of 1,334 interventions during the 2-year study period. The 4 major categories of interventions included patient counseling, drug utilization review, medication therapy management, and drug information. Each category was further subdivided into subcategories, for a total of 18 distinct subcategories. The economic impact per intervention was approximately $30. The average cost avoidance was estimated to be $357.62 per intervention, with a total economic impact of $40,020 and cost avoidance of $477,065 for the study period. Pharmacist interventions resulted in a significant amount of economic impact and cost avoidance for the health system. Using the data from the study, we created a cost estimate to indicate the value of each ambulatory care intervention by using the health system's intervention documentation system.

A New Methodology to Estimate Drug Cost Avoidance in Clinical Trials: Development and Application.

BackgroundOncology clinical trials can lead to relevant financial savings in drug acquisition for healthcare providers. Considerable methodological heterogeneity is observed among previous studies estimating these savings.MethodsWe developed a methodology to estimate the economic benefit obtained from the enrollment of patients into clinical trials through the analysis of drug cost avoidance. We designed a decision algorithm to determine if a clinical trial is associated with drug cost avoidance. This algorithm is based on five scenarios according to the availability or not of standard treatment, the presence or absence of a control arm (placebo or active treatment), and the provider of the medication. We considered as reference the cost of the standard treatment that the patient would have received in routine clinical practice. We standardized drug doses and treatment durations according to the literature. Costs were considered from a National Health System perspective. We applied this methodology at a single, research-active University Hospital in 2019. A cost avoidance analysis per trial and patient was carried out on cancer patients.ResultsWe analyzed 140 trials in which 198 patients were recruited. Drug cost avoidance was found in 120 trials (85.7%). The estimated total drug cost avoidance amounted to over €3,200,000. Melanoma and genitourinary tumors were the tumor types associated with the highest cost avoidance. The average drug cost avoidance per patient was €16,245.ConclusionWe describe a standardized method to estimate drug cost avoidance in clinical trials. We have applied it to all ongoing oncology clinical trials in our center. This methodology could be valuable for other centers to analyze the potential saving of clinical trials.

Impact of the oral chemotherapy pharmacist on direct cost avoidance and cost savings of oral oncolytics at an integrated health system.

e18839 Background: The impact of oncology pharmacists on patient care have been well-documented including enhanced medication safety and efficacy, increased medication adherence, improved provider and clinic burden, and increased patient and provider satisfaction. There is a scarcity of articles relating to pharmacists’ drug cost savings or cost avoidance of oncologic drugs in an oral chemotherapy management clinic within an integrated healthcare system. Cost savings and cost avoidance studies are needed to reinforce this practice and gain support and funding from hospital administration. Methods: This retrospective, observational study analyzed interventions made by oncology pharmacists in the Pharmacist-Managed Oral Chemotherapy Clinic at Kaiser Permanente San Diego and determine the direct drug cost savings and cost avoidance effects over one year. Cost savings and cost avoidance were calculated by comparing the costs of drug utilization if no interventions were implemented versus costs of drug saved from accepted interventions for dose reduction, dose delay, temporary dose hold, therapy discontinuation, therapy conversion, formulary alternative conversion, and brand to generic conversion. Secondary outcomes included the highest and average cost avoidance per intervention, intervention type, medication, medication class, and cancer type. Additionally, interventions that did not lead to direct drug cost savings such as adverse drug reaction management, drug interaction identification, and supportive care recommendation were also recorded. The secondary endpoint was oncologist satisfaction via a six-question satisfaction survey. All documented oncology pharmacist interventions that were made in the Oral Chemotherapy Clinic from January 1 to December 31, 2021 were reviewed for study inclusion. From a report generated monthly from the electronic health record (EHR), retrospective chart review was conducted to verify whether each cost-savings intervention was truly recommended by an oncology pharmacist and if the intervention was accepted by the treating oncologist. The Average Wholesale Price (AWP) of drugs listed on Lexicomp as of November 1, 2021 was used to calculate the drug cost savings and cost avoidance. During this period, there were no changes to practice and no increased efforts to identify interventions. Results: As of September 2021, 156 interventions were identified, with a total cost savings and cost avoidance of $2,245,856. Once all data have been collected for the remainder of 2021, descriptive statistics will be used to analyze and stratify the data as appropriate. Conclusions: Pharmacist interventions in the Oral Chemotherapy Clinic led to significant overall cost savings to the health care system. It is reasonable to expect that higher cost savings will be achieved as more oral chemotherapy agents are managed by pharmacists.

Financial Impact of Medically Integrated Pharmacy Interventions on Oral Oncolytic Prescriptions

PURPOSE:As the utilization of oral cancer medications rises, it is vital that cancer centers track costs associated with these expensive medications. This research seeks to report the cost interventions associated with medically integrated pharmacies (MIPs) and mail-order pharmacies.METHODS:Data collection occurred from October 2016 through May 2021. Volunteers input data from their oncology practice into NCODA's Cost Avoidance and Waste Tracker tool, an innovative easy-to use tool that allows practices to document any cost saving interventions or waste occurrences.RESULTS:The Cost Avoidance and Waste Tracker tool was used by nearly 50 MIPs across the country. Specifically, 26 practices submitted cost avoidance data, and 37 practices tracked waste associated with oral oncolytic therapy. Among the 26 practices, 677 cost avoidance events led to a total cost avoidance of $7,057,053.73 US dollars (USD). The net cost avoidance for the MIP's was $6,510,971.28 USD compared with $546,082.45 USD for the external mail-order pharmacies. Among the 37 practices that reported waste, 768 events were reported, leading to a total drug waste of $11,275,642.16 USD. Of that, $8,935,612.15 USD was attributed waste from external mail-order pharmacies, whereas $2,429,592.01 USD worth of drug waste was reported from MIPs.CONCLUSION:Medically integrated dispensing of oral oncolytic therapies allows for increased pharmacy oversight, leading to increased cost avoidance and reduced waste for patients and third-party payers. Although these data are difficult to compare because of the complexity of workflows at different dispensing sites, the real-world financial differences between medically integrated dispensing and mail-order pharmacies appear to be significant.

Emergency medicine pharmacist interventions reducing exposure to costs (EMPIRE-C)

Emergency Medicine (EM) pharmacists are considered essential healthcare providers in the Emergency Department (ED). Limited data are available representing the types of interventions performed by ED pharmacists, especially in community-based health systems. Retrospective, multi-centered, observational review of documented EM clinical pharmacist interventions into the electronic medical record (EMR) across five separate EDs between July 1, 2020 and June 30, 2021. Interventions were separated into three categories: ED Intervention, ED Outpatient Culture Review, and ED Discharge Antimicrobial Review. Interventions with supporting literature related to cost avoidance were also analyzed. A total of 23,794 interventions were logged by the EM pharmacy team between the three categories. Of those, 9181 were cost avoidance interventions resulting in $5,350,755.63 in total cost avoidance, or $582.81 per intervention. EM pharmacists practicing in community settings have a substantial impact on patients as evidenced by the large quantity and variety of interventions logged which also results in significant cost avoidance to the healthcare system.

Impact of a pharmacist driven anticoagulation reversal program at a large academic medical center.

In major/life-threatening bleeding, administration of timely and appropriate reversal agents is imperative to reduce morbidity and mortality. Due to complexities associated with the use of reversal agents, a clinical pharmacist-driven anticoagulation reversal program (ARP) was developed. The goal of this program was to ensure appropriateness of reversal agents based on the clinical scenario, optimize selection and avoid unintended consequences. This study describes the impact of a pharmacist-driven anticoagulation program on patient outcomes and cost. A single center retrospective chart review of adult patients whom the ARP was consulted from October 2018 to January 2020 was performed. Patients were included in the efficacy analysis if they were > 18years of age and presented with acute bleeding. Patients were excluded from the efficacy analysis if the recommended reversal agent was not administered, if a repeat head CT was not available for patients who presented with intracranial hemorrhage (ICH), or if the patient was not bleeding. All patients were included in the economic evaluation. The primary outcome was the percentage of patients who achieved effective hemostasis within 24h of anticoagulation reversal. Secondary outcomes include incidence of thromboembolic events, in-hospital mortality, and cost avoidance. One hundred twenty-one patients were evaluated by the ARP with 92 patients included in the efficacy analysis. The primary sites of bleeding were ICH in 46% and gastrointestinal (GI) in 29%. Hemostasis was achieved in 84% of patients. Thrombotic events occurred in 7.4% of patients and in-hospital mortality was 26.4%. Total cost avoidance was $1,005,871.78. To our knowledge, this is the first study to evaluate the impact of a pharmacist-driven ARP on clinical and economic outcomes. Implementation of a pharmacist-driven ARP was associated with favorable outcomes and cost savings.

Abstract P185: Feasibility and Outcome of Pharmacist-Enhanced Stroke Rounds

Background: Treatment of stroke patients is complex. Multidisicplinary rounds have been shown to decrease 30-day readmission rates, improve efficiency in work flow, communication between disciplines and promote patient-centered care. Pharmacy-enhanced intensive care unit rounds reduce adverse drug events (ADE) and provide real-time resource for drug selection, interaction and dosages. Reports on the feasibility of pharmacist-enhanced stroke rounds (PEnSR) and its effect on outcomes are few. Objective: Determine the effect of a pharmacy-enhanced stroke-rounds on patient and healthcare outcomes. Methods: A performance improvement analysis was done in the University of Mississippi Medical Center from September 1, 2019 to November 30, 2019. A pharmacist assigned to the stroke service performed medical reconciliation, monitored drug interaction, provided recommendations on drug choice and dosages for the stroke patients and alerts on medication errors. The primary outcome includes the proportion and severity of medication errors detected utilizing the EPIC iVent tool. The secondary outcomes include characteristics of interventions to prevent an ADE, cost-avoidance based on the errors and cost-analysis for the continued presence of a pharmacist for stroke rounds based on time spent to perform the role. A feedback-survey regarding the pharmacist was done at the end of analysis period. Results: A total of 77 interventions were performed during 2 month with a total cost avoidance of $40,250. Most common errors were minor. The most common intervention by the pharmacist was to initiate orders followed by discontinuing orders. Overall time spent daily for the stroke service was 5-hours. All residents and attendings of the stroke service were aware of the pharmacist’s presence, utilized the service and perceived that the PEnSR was beneficial. Conclusion: PEnSR was feasible and cost-effective and allows for the pharmacist to still contribute to other roles in the hospital. PEnSR also improves patient-centered care for stroke patients by preventing ADE resulting in hospital savings of ~$20,000/month. The UMMC-Stroke team has adapted PEnSR as part of the daily multidisciplinary stroke care.

Economic impact of pharmacist interventions in pediatric ambulatory care clinics

ObjectivesAmbulatory care pharmacists have a unique opportunity to identify and prevent adverse drug events (ADEs) throughout a patient’s treatment course. These interventions can reduce unexpected clinic visits or hospitalizations, which may lead to decreased health care costs. However, research on this topic has not been conducted in the pediatric population. This study explored the economic impact of pharmacist interventions related to ADEs in pediatric ambulatory care clinics. The primary objective was to determine the total cost avoidance of pharmacist interventions associated with the prevention or management of ADEs in pediatric ambulatory care clinics. The secondary objectives were to describe and quantify pharmacist interventions related to the prevention and management of ADEs in pediatric ambulatory care clinics. MethodsPharmacist interventions from pediatric ambulatory care clinics were collected from an electronic health record. These interventions were categorized into 1 of 4 categories: Drug interaction, drug not indicated, prevent or manage ADE, or prevent or manage drug allergy. A review panel consisting of ambulatory care pharmacists reviewed the interventions. The expected probability of the event occurring was classified according to the Nesbit method (0-0.6), and the level of care necessary to treat the potential ADE was determined. The levels of care included hospitalization, ambulatory care, and self-care. The cost avoidance associated with each prevented ADE was calculated by multiplying the probability of the ADE occurring by the average charge of the expected level of care. ResultsOf the 8755 interventions documented, 212 were included, leading to a total cost avoidance of $307,210 (range $76,802-$1,071,053). The estimated cost avoidance from each ADE subtype was $128,283 from drug interaction, $20,727 from drug not indicated, $157,993 from prevent or manage ADE, and $207 from prevent or manage drug allergy. ConclusionPediatric ambulatory care pharmacists optimize health care cost savings through the prevention and management of ADEs as integrated members of the health care team.

Cost Avoidance Analysis of Medication Conversions on the Treatment of Gastroesophageal Reflux Disease in a Medication Therapy Management Call Center: A Budgetary Perspective

BACKGROUND The burden of prescription drug prices affects patients and health system, creating a need for pharmacists to use their medication expertise to recommend the most cost-effective treatment for patients. OBJECTIVE The study aimed to analyze the cost avoidance for medication conversions related to GERD from an integrated medication therapy management call center. METHODS A quasi-experimental study was conducted at a call center during a 12-month intervention. Adult patients aged ≥18 years who received highercost PPIs were included. The pharmacists provided MTM services to patients telephonically to review all aspects of the patients’ medication regimen as well as conversion recommendation to lower-cost PPIs. The cost avoidance analysis and sensitivity analysis were conducted. RESULTS Of 40 eligible patients, 9 patients accepted the medication conversion, resulting in a 22.5% acceptance rate. The total cost avoidance from medication conversions was $19,937.1 per year, which equated to $2,215.2 per patient. The adjusted cost avoidance of medication conversion was estimated by assuming the patients who accepted the conversion continued taking the medication for 365 days and resulted in a total savings of $40,370.7 per year, which equated to $4,485.6 per patient. There were no significant association between the acceptance of medication conversions and patient’s age(P = 0.15), gender(P = 0.73), and insurance status(P = 0.96). CONCLUSION The study results showed that the call-center MTM with medicationconversion interventions successfully demonstrated an economically advantageous impact from a budgetary perspective. Further studies should explore methods to increase acceptance of MTM services and promote awareness of the profound effect on public health and well-being.

Cost Avoidance from Automated Dose Rounding of Biological and Cytotoxic Anticancer Drugs in an Integrated Delivery Network

Background: Projected costs of cancer care are expected to reach $172.8 billion dollars by 2020[1]. Cost of oncology drugs have outpaced other areas[2] with novel drugs priced at a median of $115,981/year between 2009 and 2013[3], making cost control an important priority. Rounding drug doses to the nearest vial size, as long as the difference is smaller than an accepted percentage, has been shown to reduce the cost of care[4]. This also allows workflow efficiency by simplifying compounding and decreasing waste documentation[5] and reduces the potential for medication errors[6]. Dose rounding has been recommended by the Hematology/Oncology Pharmacy Association (HOPA)[5] and the HOPA position paper was endorsed by NCCN[7]. Methods In accordance with HOPA position statement, an integrated community-based healthcare system comprised of 13 providers across 8 infusion centers implemented dose rounding to the nearest vial if within 10% based on actual calculated dose for biological and cytotoxic agents. Performed manually by oncology pharmacists at the time of initial introduction in January 2020, this was transitioned to automated dose rounding by the oncology chemotherapy software (Epic Beacon, Epic Systems, Verona, WI) in June 2020. To facilitate provider adoption and maximize cost-savings, we compiled a list of 31 biological and chemotherapy agents that provided the greatest therapeutic margin and potential for cost savings. Dose rounding parameters for each agent was developed to standardize and facilitate automated dose rounding. Lower and upper bounds were set so that the vial size was within 10% of the actual calculated dose (e.g. doses between 91 mg and 111 mg to a 100 mg vial, Table 1). Cost avoidance was calculated based on the acquisition price of the lowest vial size available and necessary to make the pre-rounded dose. Results Total cost avoidance between January 2020 and July 2020 by dose rounding 31 different chemotherapy and biological agents was $679,780.02. Automated dose rounding drugs introduced in June 2020 high value drugs resulted in cost savings of $ 112,994.12 over a seven week period. Dose rounding of biological drugs accounted for 89.4% of the total cost savings. Rounding of cytotoxic drugs resulted in a cost saving of $71,588.35. Trastuzumab dose rounding was associated with the greatest amount of cost avoidance of $147,194.44, accounting for 21.65% of total cost avoidance. Dose rounding up to the nearest vial ranged between 0.13%-9.75% (median 3.52%). Dose rounding down to the nearest vial ranged between -0.10% -9.93% (median -3.36%). Conclusions: We demonstrate feasibility of implementing an automated EHR based dose rounding protocol in an integrated delivery network, widespread adoption across multiple centers and significant cost avoidance accrued from the intervention. Similar dose rounding protocols should prioritize biologics agents due to their high utilization and costs.