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ASCO 2017: Same-Day Dosing Cuts Costs

Tony Hagen @oncobiz
Published: Friday, May 26, 2017

Researchers achieved cost savings and cut down on the amount of drug they had to throw away by pooling drug vials and dosing all patients with a given disease on the same day of the week, according to data released ahead of the 2017 ASCO Annual Meeting.

Additional study results to be presented at ASCO show that the clinical value of newly launched agents appears to be declining relative to rising costs of novel drugs, dose reductions don’t result in savings on oral oncolytics, and expanded indications for drugs constitute a financial risk for clinics enrolled in bundled or shared savings plans.

The ASCO meeting is from June 2-6 next week in Chicago.

Dosing Patients in Batches for Savings

Researchers in Canada achieved significant cost savings using an expensive agent whose minimum size vials were larger than necessary for average patient dosing by scheduling dosing for all patients on the same weekday.1 Any unused drug was saved and used to treat other patients.

The study, conducted at the Princess Margaret Cancer Center in Toronto, Canada, focused on use of the taxane cabazitaxel (Jevtana) for patients with metastatic castrate resistant prostate cancer (mCRPC). The drug costs $96.70 Canadian dollars (CAD) per mg and comes prepackaged in 60 mg single-dose vials, a quantity higher than the average prescribed dose. The researchers said that despite a discount offered by Sanofi to help cover the costs of drug wastage, many centers still cannot afford to administer the drug.

“We investigated whether aggressively batching patients on the same day and allowing for excess drug to be used for subsequent patients can result in cost savings,” the authors wrote. From September 2015 to September 2016, all mCRPC patients receiving cabazitaxel at Princess Margaret were treated only on Mondays. Patients were dosed according to clinical parameters, and hospital staff tracked the number of vials used and the amount of drug wasted.

During the trial period, 28 patients received cabazitaxel therapy until disease progression or toxicity. In total, they underwent 117 individual treatment sessions administered on 53 treatment days. With the batching system, 91 cabazitaxel vials were used, in comparison with 117 vials that would have been required with standard practice. As a result, 26 vials were unopened, and the hospital saved $149,760 CAD, a 22.2% cost reduction over 1 year.

During the study, $121,154 CAD worth of cabazitaxel was wasted, compared with $251,808 CAD worth of drug that would have been wasted without batching, for a savings of $130,656 CAD.

The authors concluded that batching with cabazitaxel at a single treatment center was feasible and resulted in significant reduction in wastage. “This approach could be applied to centers with adequate patient volumes to save costs and reduce a key barrier to the use of cabazitaxel. A similar strategy can also be applied to other drugs across the field of oncology and has similar implications for cost savings,” they wrote.

Value of Drugs Declines Relative to Cost

A research team in Toronto has concluded that the rising cost of new oncology drugs actually exceeds their added clinical benefit.2 In fact, the value of novel agents appears to be decreasing, they said.

Noting an average 10% annual increase in the price of new drugs from 1995 to 2013, researchers from the Sunnybrook Health Sciences Centre and the Odette Cancer Centre sought to determine whether the clinical benefit of new drugs was keeping pace with rapidly growing drug prices.

The researchers studied novel drugs from randomized controlled trials (RCTs) whose data was used to inform FDA drug approvals from January 2006 to August 2015. For each drug, only the first FDA-approved indication was studied. The clinical benefit of drugs was measured with ASCO’s Value Framework and the ESMO Magnitude of Clinical Benefit Scale. Drug launch prices were obtained from Red Book, an online compendium of drug price and benefit information. Drug costs were based on a 28-day supply.

The study included 40 RCTs, and whereas the 28-day drug costs were significantly associated with the FDA approval year, with an average 8.5% increase each year, the ASCO and ESMO clinical benefit scores (26 and 3, respectively) were not statistically associated with FDA approval year (P = .73 and P = .86).

The authors concluded that “the rising cost of novel oncology drugs over time is not associated with an increase in their clinical benefit, suggesting a decrease in their value over time.”

Dose Reductions Don’t Result in Savings

Researchers from the same Canadian institutions sought to determine whether dose reductions resulted in lower costs for oral oncolytics. Whereas there is a general expectation that the cost of drugs should go down with dose reduction, decreased dosing of oral cancer drugs generally does not result in lower costs, they concluded.3

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