Weight-based dosing strategy could sharply reduce spending on U.S. cancer drugs
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Key takeaways:
- A simulation study showed Veterans Health Administration baseline annual spending for cancer drugs totaled about $537 million.
- Using weight-based dosing, dose rounding and pharmacy-level vial sharing could save $74 million.
Combining weight-based dosing and single-use vial sharing within individual Veterans Affairs hospitals could reduce immune checkpoint inhibitor spending by millions annually, according to study results published in Health Affairs.
Researchers recommended adopting stewardship measures to improve the cost-effectiveness of cancer care in the United States.
“Cancer treatment is often effective but is prohibitively expensive for patients and payers,” Garth W. Strohbehn, MD, MPhil, assistant professor of hematology/oncology at Michigan Medicine and research scientist with Ann Arbor VA Center for Clinical Management Research, told Healio. “There isn’t much attention paid to the crafting of strategies that allow us to ‘have our cake and eat it, too.’ We’re trying to find ways to preserve the outcomes that patients care about while also containing costs. That’s crucial to cancer care’s long-term sustainability.”
Rationale and methodology
Strohbehn and colleagues conducted a case-control simulation study using Veterans Health Administration data from patients who received at least one dose of an immune checkpoint inhibitor from a VA medical center in 2021.
The analysis included data on 49,851 individual patient–level immune checkpoint inhibitor administration events for 8,276 patients.
Researchers performed the simulation using weight-base dosing and single-use vial sharing within each VA hospital’s pharmacy.
They pooled data from the Veterans Health Administration and Medicare drug prices to estimate reductions in immune checkpoint inhibitor use and spending that could be achieved through these pharmacy-level stewardship strategies.
Findings
Researchers calculated baseline annual Veterans Health Administration spending of $537 million annually for immune checkpoint inhibitors.
Combining weight-based dosing, dose rounding and pharmacy-level vial sharing could lead to savings of $74 million, or 13.7%, researchers concluded.
“In principle, it is possible to save a lot of money on the payer side by using evidence-based doses that are personalized for each patient — dose determined by patient’s weight — and combining that approach to dosing with operational changes at the pharmacy level that are also supported by evidence. This may include vial-sharing and dose-rounding, without sacrificing effectiveness,” Strohbehn said. “Specifically for the Veterans Health Administration and for this class of drugs, the potential cost savings are in the tens of millions of dollars per year. Previous studies of the U.S. health care system writ large put the savings closer to billions of dollars annually.”
Implications
Adoption of stewardship measures may greatly improve cost-effectiveness of cancer care in the United States, researchers concluded.
“The findings should prompt those of us in the cancer care ecosystem — including patients, prescribers, caregivers, payers and regulators — to ask ourselves: ‘For the individual patient in front of me, does this next milligram of drug that I am prescribing provide additional value?,’” Strohbehn told Healio. “It certainly adds cost, but it may not add value.
“For most research, implementing the change is difficult, and this is no different,” Strobehn added. “Continuing to educate patients and caregivers, payers and prescribers is essential, and piloting vial-sharing programs in health care systems that are incentivized to both take excellent care of patients while also containing costs is the right next step.”
References:
- Bryant AK, et al. Health Aff. 2023;doi:10.1377/hlthaff.2023.00102.
- Changing the way we deliver immune-based cancer drugs could reduce costs by 14% (press release). Available at: https://www.newswise.com/articles/changing-the-way-we-deliver-immune-based-cancer-drugs-could-reduce-costs-by-14. Published July 11, 2023. Accessed August 22, 2023.
For more information:
Garth W. Strohbehn, MD, MPhil, can be reached at gstrohbe@umich.edu.
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