Hospital Pharmacy - June 2017 - 424

424

Hospital Pharmacy 52(6)

Figure 1. Algorithm to determine opportunity for outpatient administration of rituximab.

R-HCVAD: Rituximab, cyclophosphamide, vincristine, doxorubicin, dexamethasone, high dose methotrexate, and high dose cytarabine; R-MVP: Rituximab,
Methotrexate, Procarbazine, Vincristine; RICE: Rituximab, Ifosfamide, Carboplatin, etoposide; R-HDMTX: Rituximab, High-Dose Methotrexate;
R-MTX-ARAC: Rituximab, Methotrexate, Cytarabine; DA-R-EPOCH: Dose-Adjusted EPOCH (Etoposide, Prednisone, Vincristine, Cyclophosphamide,
Doxorubicin), Rituximab; R-CVP: Rituximab, Cyclophosphamide, Vincristine, Prednisone; R-CHOP: Rituximab, Cyclophosphamide, Doxorubicin,
Vincristine, Prednisone; R-BAC: Rituximab, Bendamustine, Cytarabine; VIPER: Bortezomib, Ifosfamide, Dexamethasone, Etoposide, Cisplatin, Rituximab;
R- DHAX: Rituximab, Dexamethasone, Cytarabine, Oxaliplatin; R- DHAP: Rituximab, Dexamethasone, Cytarabine, Cisplatin.

Historical purchasing information obtained from the
primary wholesaler of the health system was utilized to
determine the total expenditure for trastuzumab, rituximab, and bevacizumab in each period. The purchasing
information provided by the wholesaler included 7 of the
8 entities within the health system and included 340B purchases for all eligible entities. During the period studied,
the 3 drugs evaluated did not have GPO contracts with the
health system; therefore, the acquisition costs were limited to WAC and 340B.
The cost minus discount was obtained mathematically
due to the inability to access the terms of the wholesaler
cost minus discount contracts for each entity. The purpose of analyzing purchasing information in the period
prior to October 1, 2014, was solely to obtain the cost
minus discount mathematically. The cost minus discount
was calculated by dividing the difference between WAC
and vial purchase price by WAC, where WAC and purchasing price were obtained directly. To determine the
financial effect of the distribution change, the calculated
cost minus discount was applied to the study period
expenditure.
Cost Minus Discount =

( WAC − Price Per Vial )
WAC

.

Study Period Price Per Vial = Study Period WAC −
 Study Period WAC × 

.
 Cost Minus Discount 

Opportunity Analysis
An opportunity cost analysis was conducted for 3 institutions
within the health system that had the same Electronic Health
Record (EHR) implemented (EPIC, Version 2014, Verona,
Wisconsin) to facilitate consistent data collection and review
of information. The analysis was performed to characterize
inpatient utilization of trastuzumab, rituximab, and bevacizumab, and identify potential methods to compensate for the
financial burden caused by Genentech's change in distribution
model. Patients who received at least one dose of trastuzumab,
rituximab, or bevacizumab within the 3 health system entities
between April 1, 2014, and September 30, 2015, were included
in the opportunity cost analysis. These dates were determined
based on EPIC implementation at each respective entity. Two
of the health system entities included in the cost analysis
implemented EPIC in April 2014, while the other entity implemented EPIC in July 2014. Data collected from the EHR
included medication, dose, admission date and time, discharge
date and time, medication administration time, service on
administration, and International Classification of Diseases,
Ninth Revision (ICD-9) code. Data collected for each entity
before the October 1, 2014, distribution model change was
annualized for performing the opportunity cost analysis. In
total, the opportunity cost analysis was over a 2-year period.
A chart review was conducted utilizing algorithms developed by investigators for identifying doses with opportunity
to shift from inpatient to outpatient administration. The algorithms were developed in consultation with hematology/
oncology pharmacy specialists (Figures 1 and 2). Information



Table of Contents for the Digital Edition of Hospital Pharmacy - June 2017

Formal Leadership: Thrilling (and Scary) Like a Roller Coaster Ride
ISMP Medication Error Report Analysis
Cancer Chemotherapy Update: Bevacizumab, Etoposide, and Cisplatin Regimen for Refractory Brain Metastases
Formulary Drug Reviews: Plecanatide
Calcitonin Gene-Related Peptide Receptor Antagonists for Migraine Prophylaxis: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide
Significant Published Articles for Pharmacy Nutrition Support Practice in 2016
Financial Effect of a Drug Distribution Model Change on a Health System
Limited Influence of Excipients in Extemporaneous Compounded Suspensions
Improved Outcomes and Cost Savings Associated With Pharmacist Presence in the Emergency Department
Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department
Hospital Pharmacy - June 2017 - 381
Hospital Pharmacy - June 2017 - 382
Hospital Pharmacy - June 2017 - 383
Hospital Pharmacy - June 2017 - 384
Hospital Pharmacy - June 2017 - 385
Hospital Pharmacy - June 2017 - 386
Hospital Pharmacy - June 2017 - 387
Hospital Pharmacy - June 2017 - Formal Leadership: Thrilling (and Scary) Like a Roller Coaster Ride
Hospital Pharmacy - June 2017 - 389
Hospital Pharmacy - June 2017 - ISMP Medication Error Report Analysis
Hospital Pharmacy - June 2017 - 391
Hospital Pharmacy - June 2017 - 392
Hospital Pharmacy - June 2017 - 393
Hospital Pharmacy - June 2017 - Cancer Chemotherapy Update: Bevacizumab, Etoposide, and Cisplatin Regimen for Refractory Brain Metastases
Hospital Pharmacy - June 2017 - 395
Hospital Pharmacy - June 2017 - 396
Hospital Pharmacy - June 2017 - 397
Hospital Pharmacy - June 2017 - 398
Hospital Pharmacy - June 2017 - 399
Hospital Pharmacy - June 2017 - Formulary Drug Reviews: Plecanatide
Hospital Pharmacy - June 2017 - 401
Hospital Pharmacy - June 2017 - 402
Hospital Pharmacy - June 2017 - 403
Hospital Pharmacy - June 2017 - 404
Hospital Pharmacy - June 2017 - 405
Hospital Pharmacy - June 2017 - Calcitonin Gene-Related Peptide Receptor Antagonists for Migraine Prophylaxis: A Review of a Drug Class or Therapeutic Class in a Late Stage of Clinical Development
Hospital Pharmacy - June 2017 - 407
Hospital Pharmacy - June 2017 - Highly Probable Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome Associated With Lenalidomide
Hospital Pharmacy - June 2017 - 409
Hospital Pharmacy - June 2017 - 410
Hospital Pharmacy - June 2017 - 411
Hospital Pharmacy - June 2017 - Significant Published Articles for Pharmacy Nutrition Support Practice in 2016
Hospital Pharmacy - June 2017 - 413
Hospital Pharmacy - June 2017 - 414
Hospital Pharmacy - June 2017 - 415
Hospital Pharmacy - June 2017 - 416
Hospital Pharmacy - June 2017 - 417
Hospital Pharmacy - June 2017 - 418
Hospital Pharmacy - June 2017 - 419
Hospital Pharmacy - June 2017 - 420
Hospital Pharmacy - June 2017 - 421
Hospital Pharmacy - June 2017 - Financial Effect of a Drug Distribution Model Change on a Health System
Hospital Pharmacy - June 2017 - 423
Hospital Pharmacy - June 2017 - 424
Hospital Pharmacy - June 2017 - 425
Hospital Pharmacy - June 2017 - 426
Hospital Pharmacy - June 2017 - 427
Hospital Pharmacy - June 2017 - Limited Influence of Excipients in Extemporaneous Compounded Suspensions
Hospital Pharmacy - June 2017 - 429
Hospital Pharmacy - June 2017 - 430
Hospital Pharmacy - June 2017 - 431
Hospital Pharmacy - June 2017 - 432
Hospital Pharmacy - June 2017 - Improved Outcomes and Cost Savings Associated With Pharmacist Presence in the Emergency Department
Hospital Pharmacy - June 2017 - 434
Hospital Pharmacy - June 2017 - 435
Hospital Pharmacy - June 2017 - 436
Hospital Pharmacy - June 2017 - 437
Hospital Pharmacy - June 2017 - Patients Given Take Home Medications Instead of Paper Prescriptions Are More Likely to Return to Emergency Department
Hospital Pharmacy - June 2017 - 439
Hospital Pharmacy - June 2017 - 440
Hospital Pharmacy - June 2017 - 441
Hospital Pharmacy - June 2017 - 442
Hospital Pharmacy - June 2017 - 443
Hospital Pharmacy - June 2017 - 444
Hospital Pharmacy - June 2017 - 445
Hospital Pharmacy - June 2017 - 446
Hospital Pharmacy - June 2017 - 447
Hospital Pharmacy - June 2017 - 448
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2020
https://www.nxtbook.com/nxtbooks/sage/psychologicalscience_demo
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2020
https://www.nxtbook.com/nxtbooks/sage/fai_202009
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_august2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2020
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2019
https://www.nxtbook.com/nxtbooks/sage/fai_201909
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_july2019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2019
https://www.nxtbook.com/nxtbooks/sage/canadianpharmacistsjournal_05062019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2019
https://www.nxtbook.com/nxtbooks/sage/sri_supplement_201903
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2019
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2018
https://www.nxtbook.com/nxtbooks/sage/tec_20180810
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2018
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_julyaugust2018
https://www.nxtbook.com/nxtbooks/sage/fai_201807
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2018
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_april2018
https://www.nxtbook.com/nxtbooks/sage/sri_supplement_201803
https://www.nxtbook.com/nxtbooks/sage/slas_discovery_201712
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_february2018
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_december2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_november2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_october2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_september2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_julyaugust2017
https://www.nxtbook.com/nxtbooks/sage/fai_supplement_201709
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_june2017
https://www.nxtbook.com/nxtbooks/sage/hospitalpharmacy_may2017
https://www.nxtbook.com/nxtbooks/sage/fai_201706
https://www.nxtbook.com/nxtbooks/sage/fai_201607
https://www.nxtbookmedia.com