Dose Rounding Program Results in More Than $3 Million in Savings

Oncology infusion drugs are a costly expenditure, and the Hematology/Oncology Pharmacy Association (HOPA) recommends biologics and cytotoxic agents be rounded to the nearest vial size when it is within 10% of the ordered dose to minimize waste and decrease costs.

A prospective study implemented a dose rounding protocol and found that doing so resulted in more than $3.6 million in saved healthcare expenses. The results of the study were presented by Shannon Hough, PharmD, BCOP, pharmacy manager of oncology clinical services at the University of Michigan, at HOPA’s 16th Annual Conference.

Researchers assessed the impact of dose rounding for 24 infusion medications that had high frequency use and costs. Between July 1, 2018, to June 30, 2019, the dose rounding protocol was integrated into electronic ordering systems for automatic dose rounding to minimize an impact to workflow and to reduce errors. Ordered doses were automatically rounded to the nearest vial size if it was within 10% of the original dose, and physicians reviewed the rounding prior to signing and sending the order. Physicians could opt out of this and manually enter the desired dose. Researchers used the wholesale acquisition cost to determine price per vial.

During the study period, 50% of doses were rounded: 50.4% rounded up and 49.6% rounded down. Dose rounding resulted in $3,601,728 in savings, and the average cost savings per rounded dose was $1,432.

Among the drugs studied, the top five with the highest cost savings were trastuzumab ($756,780), ipilimumab ($494,517), inotuzumab ozogamicin ($368,390), paclitaxel-protein bound ($236,348), and pemetrexed ($218,298).

Dose rounding had a greater impact in the outpatient setting: A total of 566 doses were administered in the inpatient setting, of which 107 were rounded down; comparatively, 9,640 doses were administered in the outpatient setting, of which 2,409 were rounded down.

“The drug rounding initiative has greatly decreased drug expense costs,” the authors concluded. “Further research is needed to determine how dose rounding impacts patient outcomes.”

Dela Pena J, Eschenburg K LaRocca V, et al. Financial impact of an automatic oncology drug rounding initiative: one year analysis. Presented at HOPA 16th Annual Conference. March 11-14, 2020, Tampa, Florida.