Puneeth Indurlal, MD, The US Oncology Network, McKesson, The Woodlands, TX, discusses his study on the impact of dose rounding that targets bevacizumab and its biosimilars on the total cost of care and drug waste expenditures for Oncology Care Model participants in the US Oncology Network. The study was presented at the 2023 ASCO Annual Meeting in Chicago, IL.

Transcript:

Puneeth Indurlal, MD: Hello, I'm Puneeth Indurlal. I'm Senior Director for Care Transformation at the US Oncology Network.

Can you give some background about your study and what prompted you to undertake it?

Dr Indurlal: Drug waste is an unnecessary and wasteful expenditure that contributes to the total cost of care, yet it is very avoidable. We were looking at strategies to try and mitigate that waste, or reduce that waste, and dose rounding was a tangible option that was put out in a position statement by the Oncology Pharmacist Association, and also endorsed by NCCN. Fourteen of the practices in the US Oncology Network that were participants in the Oncology Care Model implemented the dose rounding strategy variable, and we sought to evaluate what the impact of that dose rounding approach was on the total cost of care in those practices.

Can you briefly describe how the study was conducted?

Dr Indurlal: We used claims data, medical claims data, from the Oncology Care Model to look at drugs that were billed with the JW modifier on the claims, which indicated drug waste. We evaluated the drug waste prior to the implementation of the dose rounding program, and we also implemented the program in around 2018, so we evaluated the subsequent impact of the dose rounding strategy on drug waste after the implementation.

In a comparison, we were able to evaluate how many doses of drugs had waste prior to the implementation and post implementation. We were also able to evaluate what is the contribution of drug waste to the cost prior and after the strategy was implemented.

What were the key findings of your study?

Dr Indurlal: The successful implementation of the strategy actually led to a 35% reduction in drug waste on the drugs that we evaluated as a part of the study. We also noticed that more than half of the waste coming from very higher doses were significantly reduced.

As part of this evaluation, we calculated that there was almost a 1% savings to total cost of care. Prior to the implementation, about $156 per episode per month was attributable to drug waste. Post implementation, that reduced down to $55. So we were able to effectively save $100 per member episode per month in the program, which is about 1% reduction.

Looking ahead, what potential impact do you hope your findings will have on patient service and personalized care navigation?

Dr Indurlal: This approach was implemented not just with the drugs that we evaluated in the study, but also many other medications. So we found that the same strategy could be applicable to other medications, biologicals as well as cytotoxic agents. It is a hopeful approach and it is also a tangible approach to generate savings in total cost of care models. It also reduces wasteful spending from the health care system, so it benefits the health care system, the patient, as well as the providers who are implementing these strategies as part of our patient care programs.

Is there anything else you'd like to add?

Dr Indurlal: I think one of the things that we want to look at is appropriate dosing strategies for medications. Appropriate dosing strategies could include dose rounding, but also other approaches like dose banding or tailoring doses that would have fewer wasteful expenditures contributed the total cost of care.