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Reimbursement and Managed Care News

By Stanton R. Mehr
Published: Tuesday, Jun 15, 2010
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Cost Is Creeping Into the Therapy Decision-Making Discussion

In years past, physicians have avoided the question as to whether cost of therapy should be considered in the treatment approach. As biologic therapy can cost far more than conventional pharmaceutical treatments, and patients are often asked to shoulder significant portions of that cost, it may be time to take the blinders off, according to an oncology roundtable.

At the National Comprehensive Cancer Network’s (NCCN) annual conference, roundtable participants suggested that it may be time to include cost information in treatment guidelines. Leonard Saltz, MD, of the Memorial Sloan-Kettering Cancer Center, New York City, claimed that physicians used to be “above the idea of considering cost.” That is no longer the case, according to the panelists.

David Ettinger, MD, of Johns Hopkins University, Baltimore, noted that if the guidelines (either from NCCN or other professional cancer societies) included cost data along with treatment protocols, “it might help doctors decide between two chemotherapy regimens for colorectal cancer that are similarly effective but vary widely in their cost.”

In related news, a survey of oncologists and rheumatologists regarding biologic therapy revealed that both of these specialists are now considering a cost discussion with their patients during the office visit.

The Biotechnology Monitor & Survey found that when nearly 100 physician practices were queried, two-thirds of rheumatologists responded that the costs associated with therapy had “more often become part of the conversation.” Sixty-two percent of responding rheumatologists said that when prescribing biologics, they considered the cost of therapy “frequently” or “all the time.” In comparison, 46% of oncologists talk to their patients about their out-of-pocket costs, and 48% considered cost of therapy at least frequently.

Interestingly, only 14% of rheumatologists indicated that cost is never considered in therapeutic decision making. Nineteen percent of the responding oncologists claimed to never consider cost of therapy in the clinical decision.


Presented at the 13th Annual Meeting of the National Comprehensive Cancer Network, Hollywood, FL,

March 5–9, 2008.

   2008
Biotechnology Monitor & Survey. Emron, Wayne, New Jersey, 2008 (www.biotechmonitor. com).






Rounding Down Chemotherapy Doses: Does It Save Money for the Health System?

Drug wastage—the bane of pharmacy practice— and trying to avoid it is drummed into the head of retail pharmacists around the country. It is one thing to talk about wastage for a generic beta blocker for hypertension, for which the cost is nominal, but for a higher-cost chemotherapeutic agent, the amount of money lost in drug wastage is assumed to be very high—or is it? Pharmacists from the Veteran Affairs Health Care Center in Palo Alto, California, sought to quantify how much could be saved by enforcing the common practice of “rounding down” chemotherapy doses to the nearest vial unit size in their ambulatory infusion center, thus reducing or eliminating wastage of certain products.

The pharmacists reviewed the records of patients given infused chemotherapy over six months, ending April 30, 2007. Drug acquisition costs were used to estimate how much wastage was avoided in patients whose doses were rounded down and how that translated into cost savings to the center.

They found that one-quarter of the 333 patients receiving infused chemotherapy had their doses rounded down an average of 2% to the next vial size over the six months. The amount of chemotherapy saved was 2.3 g (230 mL), and the creation of 40 partial vials. The pharmacists calculated that the cost saved by the health care center was $6,600, which is the equivalent of $13,100 based on average wholesale price.

Although they did not study the clinical outcomes in the patients with cancer who received the lower doses, rounded down to the next vial size, the researchers believe that the practice does save significantly in drug acquisition cost and spares needless environmental waste.


Nguyen C, Miyahara RK, Joshi R: Cost avoidance associated with rounding down chemotherapy doses by a pharmacist in the ambulatory infusion center. Presented at the 2008 annual meeting of the Academy of Managed Care Pharmacy, San Francisco, April 16–19, 2008.






HER2 Testing and Treatment Patterns in Breast Cancer

Accurately gauging whether a woman is human epidermal growth factor receptor (HER) positive is essential to prescribing the most effective treatment. Biologic agents like trastuzumab are most effective in patients who test positive for HER2. However, little trial information is available to detect whether adequate molecularmarker testing precedes the decision to prescribe trastuzumab.

Researchers from HealthCore, Wilmington, Delaware, evaluated administrative claims databases from three health plans. The records of patients with breast cancer who were diagnosed over 13 months, ending June 30, 2006, were chosen for review.


View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: Bridging the Gaps Around Oncology Biosimilars: Assessing the Potential Impact of Emerging Agents to PracticeSep 29, 20181.5
Community Practice Connections: Oncology Best Practice™ Targeting Cell Cycle Progression: The Latest Advances on CDK4/6 Inhibition in Metastatic Breast CancerOct 31, 20181.0
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