1 Englewood Hospital and Medical Center, Englewood, New Jersey.
2 Englewood Hospital and Medical Center, Englewood, New Jersey, and Rutgers University Ernest Mario School of Pharmacy, Piscataway, New Jersey.
J Manag Care Spec Pharm. 2018 Oct;24(10):1028-1033. doi: 10.18553/jmcp.2018.24.10.1028.
Infliximab dose rounding is a commonly accepted practice at many institutions to contain costs. Currently, there is limited data on the clinical and financial implications of infliximab dose rounding standardization.
To determine whether standardized infliximab dose rounding is comparable with nonstandardized dosing in patients with Crohn's disease or ulcerative colitis in terms of cost and efficiency, using a cost comparison between the 2 dosing methods at an outpatient infusion center attached to a community teaching hospital.
A retrospective electronic chart review was conducted to identify patients who received infliximab for ulcerative colitis or Crohn's disease over a 6-month period. The primary endpoint was cost comparison between the 2 dosing methods. The secondary outcomes were estimated time taken for order verification, number of order clarifications, increase in dose or frequency of infliximab, number of patients who switched to alternative therapy, and use of medications for adverse drug effects. Descriptive statistics and Fisher's exact test were used for data analysis.
72 patients met the inclusion criteria. Because of patient overlap during the study period, 45 patients (62.5%) were in the standardized rounding arm, and 69 patients (95.8%) were in the nonstandardized rounding arm. One patient in each arm required an increased dose or frequency of infusion (2.2% vs. 1.5%, P = 1.000). Standardized infliximab dose rounding had a theoretical cost savings of at least $104,640 per year (based on our rough annual census of 480 patients) compared with the nonstandardized method that had been used previously. The cost savings can also be translated as $218 per patient per month on average. The mean times to order verification were 10 vs. 12 minutes in the nonstandardized and standardized groups, respectively. Two patients in the nonstandardized group switched to alternative therapy. There was no difference in usage of rescue medications for adverse drug effects.
Standardization of infliximab dose rounding resulted in increased efficiency in the pharmacy workflow by reducing time for order verification. Furthermore, standardized dose rounding resulted in a significant reduction in expenditure for infliximab for the institution.
No outside funding supported this research. The authors have nothing to disclose. This research was presented as a poster at the ASHP Midyear Clinical Meeting & Exhibition 2017; December 3-7, 2017; Orlando, FL.
在许多机构中，将英夫利昔单抗剂量四舍五入是一种常用的控制成本的方法。目前，关于英夫利昔单抗剂量标准化四舍五入在克罗恩病或溃疡性结肠炎患者中的临床和经济影响的数据有限。
在一家社区教学医院的门诊输液中心，通过两种给药方法的成本比较，确定在成本和效率方面，标准化英夫利昔单抗剂量四舍五入与非标准化给药是否可比。
对 6 个月内接受英夫利昔单抗治疗溃疡性结肠炎或克罗恩病的患者进行回顾性电子病历审查。主要终点是两种给药方法的成本比较。次要结局是估计医嘱核对时间、医嘱澄清次数、英夫利昔单抗剂量或频率增加、需要改用替代疗法的患者人数以及药物不良反应的药物使用情况。采用描述性统计和 Fisher 确切检验进行数据分析。
72 名患者符合纳入标准。由于研究期间患者重叠，45 名患者（62.5%）处于标准化四舍五入组，69 名患者（95.8%）处于非标准化四舍五入组。两组各有 1 名患者需要增加剂量或增加输注频率（2.2%比 1.5%，P=1.000）。与之前使用的非标准化方法相比，标准化英夫利昔单抗剂量四舍五入每年至少节省 104640 美元（基于我们每年粗略估计的 480 名患者）。节省的费用也可以平均换算为每位患者每月 218 美元。非标准化组和标准化组的医嘱核对时间分别为 10 分钟和 12 分钟。非标准化组的 2 名患者改用替代疗法。药物不良反应的抢救药物使用无差异。
通过减少医嘱核对时间，英夫利昔单抗剂量四舍五入的标准化提高了药房工作流程的效率。此外，标准化剂量四舍五入使机构的英夫利昔单抗支出显著减少。
本研究无外部资金支持。作者没有要披露的内容。这项研究作为海报在 2017 年 ASHP 中期临床会议和展览会上展示；2017 年 12 月 3 日至 7 日；佛罗里达州奥兰多。
