Does M&S Help? Operationalizing Cost Avoidance and Proficiency Evaluations

A pharmacy-managed anemia program included distribution and clinical components, with the goal of making epoetin alpha therapy for hemodialysis patients more cost-effective. The Pharmacy Department prepared epoetin alpha doses for patients in unit-dose syringes, utilizing and documenting vial overfill. Pharmacists dosed epoetin alpha and iron (oral and intravenous) per protocol for new and established patients. Baseline data were obtained in 1994, one year prior to implementation of the program, and were re-evaluated in 1995 and 1998. Cost avoidance from utilization of epoetin alpha vial overfill in 1995 and 1998 was $83,560 and $91,148 respectively. In 1995 and 1998, cost avoidance from pharmacy management of anemia was $191,159 and $203,985 respectively. The total cost avoidance from 1995 through 1998 was estimated at $1,018,638. The number of patients with hematocrits under 31% decreased from 32% in 1994 to 21% and 14% in 1995 and 1998 respectively. We conclude that a pharmacy-managed anemia program for hemodialysis patients results in significant cost savings and better achievement of target hematocrits.

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Methods used to attribute costs avoided from pharmacist interventions in acute care: A scoping review

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab214 ◽

2021 ◽

Author(s):

Sujita W Narayan ◽

Ivo Abraham ◽

Brian L Erstad ◽

Curtis E Haas ◽

Arthur Sanders ◽

...

Keyword(s):

Acute Care ◽

Scoping Review ◽

Pharmacy Practice ◽

Economic Implications ◽

Medline Search ◽

Cost Avoidance ◽

Harmful Consequence ◽

Pharmacist Interventions ◽

Acute Care Settings ◽

Human Participants

Abstract Purpose Cost-avoidance studies are common in pharmacy practice literature. This scoping review summarizes, critiques, and identifies current limitations of the methods that have been used to determine cost avoidance associated with pharmacists’ interventions in acute care settings. Methods An Embase and MEDLINE search was conducted to identify studies that estimated cost avoidance from pharmacist interventions in acute care settings. We included studies with human participants and articles published in English from July 2010 to January 2021, with the intent of summarizing the evidence most relevant to contemporary practice. Results The database search retrieved 129 articles, of which 39 were included. Among these publications, less than half (18 of 39) mentioned whether the researchers assigned a probability for the occurrence of a harmful consequence in the absence of an intervention; thus, a 100% probability of a harmful consequence was assumed. Eleven of the 39 articles identified the specific harm that would occur in the absence of intervention. No clear methods of estimating cost avoidance could be identified for 7 studies. Among all 39 included articles, only 1 attributed both a probability to the potential harm and identified the cost specific to that harm. Conclusion Cost-avoidance studies of pharmacists’ interventions in acute care settings over the last decade have common flaws and provide estimates that are likely to be inflated. There is a need for guidance on consistent methodology for such investigations for reporting of results and to confirm the validity of their economic implications.

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Is Implementation of the Care Transitions Intervention Associated with Cost Avoidance After Hospital Discharge?

Journal of General Internal Medicine ◽

10.1007/s11606-014-2814-0 ◽

2014 ◽

Vol 29 (6) ◽

pp. 878-884 ◽

Cited By ~ 29

Author(s):

Rebekah Gardner ◽

Qijuan Li ◽

Rosa R. Baier ◽

Kristen Butterfield ◽

Eric A. Coleman ◽

...

Keyword(s):

Hospital Discharge ◽

Care Transitions ◽

Cost Avoidance ◽

Is Implementation

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Cost avoidance with IV bolus cefmetazole

Inpharma Weekly ◽

10.2165/00128413-199208290-00009 ◽

1992 ◽

Vol &NA; (829) ◽

pp. 6

Author(s):

&NA;

Keyword(s):

Cost Avoidance

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Use of a Deprescribing Tool in an Interdisciplinary Primary-Care Patient-Aligned Care Team

The Senior Care Pharmacist ◽

10.4140/tcp.n.2022.34 ◽

2022 ◽

Vol 37 (1) ◽

pp. 34-43

Author(s):

Makayla W. Nelson ◽

Tara N. Downs ◽

Gina M. Puglisi ◽

Brent A. Simpkins ◽

Amy Schmelzer Collier

Keyword(s):

Primary Care ◽

Adverse Drug Events ◽

Primary Care Patient ◽

Care Patient ◽

Care Team ◽

Record System ◽

Cost Avoidance ◽

Increased Risk ◽

Medication Reviews ◽

Va Health Care System

Objective: To pilot the VIONE approach in a single Primary Care Patient Aligned Care Team (PACT). The authors aim for the Clinical Pharmacy Specialist (CPS) to perform 20 comprehensive medication reviews (CMRs) and the pilot PACT physician (PCP) to complete 200 VIONE discontinuations. Cost avoidance and CPS recommendations will also be analyzed. Polypharmacy is associated with increased risk of adverse drug events, falls, hospitalizations, and death. VIONE is a deprescribing tool that assists providers in identifying inappropriate medications. Design: Quality Improvement Setting: Single VA Health Care System (VAHCS) Participants: High-risk veterans in pilot PACT Interventions: The CPS educated the PCP regarding VIONE methodology and assisted with CMRs. When deprescribing was warranted, VIONE discontinuation reasons were selected in the Computerized Patient Record System (CPRS). Data were electronically stored in a national dashboard. Results: The authors identified 231 veterans at risk for polypharmacy-related adverse events. The PCP and CPS were able to reach 99 veterans and make 136 medication discontinuations between September 1, 2019, and March 1, 2020. The CPS performed 20 CMRs, resulting in 90 deprescribing recommendations. Thirty-eight CPS recommendations were accepted and contributed $18,835.95 to the sum annualized cost avoidance of $21,904.80. Conclusion: The VIONE methodology was successfully implemented in the pilot PACT. The utilization of the CPS was associated with an increased average number of medication discontinuations per veteran and contributed to cost avoidance.

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Abstract W P302: Assessment of a New Method of Warfarin Management vs the New Oral Anticoagulants and Conventional Warfarin Management in Atrial Fibrillation

Stroke ◽

10.1161/str.46.suppl_1.wp302 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Henry I Bussey ◽

Edith Nutescu

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulants ◽

New Oral Anticoagulants ◽

Target Range ◽

Regression Equations ◽

Major Event ◽

Cost Avoidance ◽

Study Results ◽

Event Rates ◽

The Impact

PURPOSE: To assess the impact of International Normalized Ratio (INR) self testing and online remote monitoring and management (STORM2) on clinical events and costs vs. traditional warfarin management and the new oral anticoagulants (NOACs) in atrial fibrillation (AF). METHODS: Seven STORM2 trials had a weighted mean INR time in the target range (TTR) of 77.2%. Thromboembolism (TE) and major bleeding (MB) rates at 30%, 45%, 55%, 65%, and 75% TTR were calculated using linear regression equations from a systematic review of 38 AF studies. MB = 10.104 - 0.120x[TTR], (p = 0.004) and TE = 8.313 - 0.098x[TTR], (p = 0.03). MB and TE rates were sub-divided based on the distribution in the NOAC trials. TTR-based mortality was calculated based on a 6%/yr rate multiplied by the adjusted relative risks from a data base analysis of approximately 38,000 AF patients. Projected event rates at 75% TTR, expressed as number per 1,000 patient-years, were compared to event rates at lower TTR ranges and to rates reported in the NOAC trials. Differences in major event rates were used to calculate cost avoidance. RESULTS: Projected event rates with STORM2 (TTR of 75%) when compared to “conventional ” TTR of 55% to 65% were 64% to 71% lower for MB, 47% to 64% lower for TE, and 47% to 57% lower for mortality. Compared to the NOAC study results, the projected rates were 48% to 70% lower for MB, 41% to 66% lower for TE, and 40% to 53% lower for mortality. Projected cost avoidance was $10.4 million vs. a TTR of < 30%, $2.2 million vs. a TTR of 65%; and from $1.4 to $3.1 million vs the NOACs. Costs of “other” MB and TE , drug costs, and monitoring costs were not included in the estimates. CONCLUSIONS: STORM2 management of warfarin is projected to produce a 50% or greater reduction in major event rates with a cost avoidance of $1.4 to $10.4 million per 1,000 patients per year. CLINICAL IMPLICATIONS: STORM2 management may transform the safety and efficacy of anticoagulation for the millions of people with AF while substantially reducing costs. These findings warrant randomized, prospective trials in AF and other indications for anticoagulation.

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Proposed guidance on cost-avoidance studies in pharmacy practice

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab211 ◽

2021 ◽

Author(s):

Asad E Patanwala ◽

Sujita W Narayan ◽

Curtis E Haas ◽

Ivo Abraham ◽

Arthur Sanders ◽

...

Keyword(s):

Clinical Pharmacy ◽

Best Practice ◽

Pharmacoeconomic Analysis ◽

Pharmacy Practice ◽

Cost Savings ◽

Sensitivity Analyses ◽

Cost Assessment ◽

Potential Consequence ◽

Cost Avoidance ◽

Pharmacist Interventions

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Cost-avoidance studies of pharmacist interventions are common and often the first type of study conducted by investigators to quantify the economic impact of clinical pharmacy services. The purpose of this primer is to provide guidance for conducting cost-avoidance studies pertaining to clinical pharmacy practice. Summary Cost-avoidance studies represent a paradigm conceptually different from traditional pharmacoeconomic analysis. A cost-avoidance study reports on cost savings from a given intervention, where the savings is estimated based on a counterfactual scenario. Investigators need to determine what specifically would have happened to the patient if the intervention did not occur. This assessment can be fundamentally flawed, depending on underlying assumptions regarding the pharmacists’ action and the patient trajectory. It requires careful identification of the potential consequence of nonaction, as well as probability and cost assessment. Given the uncertainty of assumptions, sensitivity analyses should be performed. A step-by-step methodology, formula for calculations, and best practice guidance is provided. Conclusions Cost-avoidance studies focused on pharmacist interventions should be considered low-level evidence. These studies are acceptable to provide pilot data for the planning of future clinical trials. The guidance provided in this article should be followed to improve the quality and validity of such investigations.

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