Impact of an innovative blood factor stewardship program on drug expense and patient care

Amerine, Lindsey B.; Chen, Sheh Li; Daniels, Rowell; Key, Nigel S.; Eckel, Stephen F.; Savage, Scott W.

doi:10.2146/ajhp140722

Cited by 24 publications

(31 citation statements)

References 16 publications

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“…A retrospective cohort evaluated the impact of a pharmacist‐led blood factor stewardship program and found that total CA during 1 year was $375,539, amounting to $8941.40 per patient . A similar study found that a pharmacist working with a hematologist resulted in an annual savings of more than $4 million in blood factor stewardship . The actual cost savings for specific types of interventions were not provided.…”

Section: Results Of Scoping Reviewmentioning

confidence: 99%

“…69 A similar study found that a pharmacist working with a hematologist resulted in an annual savings of more than $4 million in blood factor stewardship. 70 The actual cost savings for specific types of interventions were not provided. An additional gap in the literature is quantification of savings from blood factors not provided, a significant means of CA within this area.…”

Section: Blood Factor Stewardship and Emergency Anticoagulation Revermentioning

confidence: 99%

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Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

et al. 2019

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A framework for evaluating pharmacists’ impact on cost avoidance in the intensive care unit (ICU) and emergency department (ED) has not been established. This scoping review was registered (CRD42018091217) and conducted to identify, aggregate, and qualitatively describe the highest quality evidence for cost avoidance generated by clinical pharmacists on interventions performed in an ICU or ED. Searches were conducted in PubMed, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from inception until April 2018. The level of evidence (LOE) for each specific category of intervention was evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation evidence‐to‐decision framework. The risks of bias for articles were evaluated using Newcastle Ottawa and Cochrane Collaboration tools. The values from all interventions were inflated to 2018 U.S. dollars using the consumer price index for medical care. Of the 464 articles initially identified, 371 were excluded and 93 were included. After reviewing references from the articles included, an additional 71 articles were also reviewed. The 38 cost intervention categories were supported by varying LOEs: IA (0 categories), IB (1 category), IIA (4 categories), IIB (0 categories), III (27 categories), and IV (6 categories), and articles mostly displayed low to moderate risks of bias. Pharmacists generate cost avoidance through a variety of interventions in critically and emergently ill patients. The quality of evidence supporting specific cost avoidance values is generally low. Quantification of and factors associated with the cost avoidance generated from pharmacists caring for these patients are of paramount importance.

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Section: Results Of Scoping Reviewmentioning

confidence: 99%

Section: Blood Factor Stewardship and Emergency Anticoagulation Revermentioning

confidence: 99%

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

et al. 2019

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“…Nevertheless, utilization patterns and outcomes may vary over time in ways that often cannot be predicted or explained, making cost predictability and budget forecasting difficult. Large prospective cohort studies can help to increase transparency and enable benchmarking between centers and regions [70][71][72][73].…”

Section: Innovative Outcome-based Care and Procurement Modelmentioning

confidence: 99%

“…The collection of real-world outcomes and utilization data from individual patients and their HCPs would facilitate cost predictability. Accurate cumulative data on populations would also provide payers with deeper insight into resource usage, real-world effectiveness, and best practice patterns across healthcare providers, hemophilia centers, regions, patient characteristics, etc [71].…”

Section: Innovative Outcome-based Care and Procurement Modelmentioning

confidence: 99%

An innovative outcome-based care and procurement model of hemophilia management

Gringeri¹,

Doralt²,

Valentino

et al. 2016

Expert Review of Pharmacoeconomics & Outcomes Research

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Hemophilia is a rare bleeding disorder associated with spontaneous and post-traumatic bleeding. Each hemophilia patient requires a personalized approach to episodic or prophylactic treatment, but selfmanagement can be challenging for patients, and avoidable bleeding may occur. Patient-tailored care may provide more effective prevention of bleeding, which in turn, may decrease the likelihood of arthropathy and associated chronic pain, missed time from school or work, and progressive loss of mobility. A strategy is presented here aiming to reduce or eliminate bleeding altogether through a holistic approach based on individual patient characteristics. In an environment of budget constraints, this approach would link procurement to patient outcome, adding incentives for all stakeholders to strive for optimal care and, ultimately, a bleed-free world.ARTICLE HISTORY

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“…Prior to the creation of the HMP, the Department of Pharmacy acted in strictly a drug acquisition and dispensing role and there existed no role for the pharmacist as part of the comprehensive care team for the hemophilia population at our medical center. Amerine et al previously described the creation of an inpatient Factor Stewardship Program, which served as a guide for the formation of the HMP at our institution . Their report demonstrated the fiscal benefit of greater pharmacist involvement in the management of factor drug formulary and clinical application to reduce expenditures and the potential for similar programs in other health systems.…”

Section: Introductionmentioning

confidence: 96%

Implementation of a hemophilia management program improves clinical outcomes

Slocum

Peksa

Webb

et al. 2018

J Am Coll Clin Pharm

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Introduction Hemophilia is a rare, inherited, coagulation disorder that impairs the body's ability to cease bleeding, making hemophiliacs susceptible to bleeding episodes. These patients often require multiple doses of clotting factor concentrates to help maintain hemostasis. In fiscal year (FY) 2016, Rush University Medical Center's drug expense for clotting factor concentrates totaled $4.6 million, which accounted for approximately 15% of the total drug budget. The Department of Pharmacy developed a Hemophilia Management Program (HMP) to improve care, reduce spending, and expand clinical pharmacy services. Prior to the HMP, the Department of Pharmacy completed drug acquisition and dispensing and no role existed for pharmacists as part of the comprehensive care team for the hemophilia population. The primary objective of this study was to evaluate clinical outcomes after implementation of clinical pharmacy services into the management of hemophilia patients in an interdisciplinary HMP. Methods Several areas for improved care and efficiency were identified prior to the implementation of the HMP: interdisciplinary education, clinical management and continuity of care, and formulary management. Results In total, implementation of the HMP resulted in a net savings of $2.7 million for clotting factor expenses for FY 2017. The cost savings based on clotting factor expenses resulted in a return on investment (ROI) of 20:1, exceeding the initial projections of a modest ROI of 3:1. In addition, these costs savings were realized with the average length of stay per patient staying within the previous margins. Finally, the HMP effectively reduced the need for blood transfusions per patient. Discussion Design and implementation of the HMP resulted in significant cost savings, improved efficiency, and enhanced clinical services for patients with hemophilia. This expansion of pharmacy services has become the first pharmacy‐led program in the country to not only reduce costs, but also improve clinical outcomes.

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Impact of an innovative blood factor stewardship program on drug expense and patient care

Abstract: Implementation of the UNCMC stewardship program has led to improved outcomes in patients receiving clotting factor concentrates, with significant institutional cost savings.

Cited by 24 publications

References 16 publications

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department

An innovative outcome-based care and procurement model of hemophilia management

Implementation of a hemophilia management program improves clinical outcomes

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