Related Experiment Videos
Balancing efficacy with cost: antiemetic control in the pediatric stem cell transplant (SCT) population
S K Parsons1, L E Hoorntje, K J Levine
1Department of Pediatric Oncology, Dana-Farber Cancer Institute 02115, USA.
Insights
Optimizing ondansetron use in pediatric stem cell transplants (SCT) can significantly cut costs. Standardizing dosing frequency, duration, and switching to oral administration offers substantial savings without compromising antiemetic efficacy.
Area of Science:
- Pediatric Hematology/Oncology
- Pharmacoeconomics
- Stem Cell Transplantation
Background:
- Intravenous (i.v.) ondansetron is frequently used in pediatric stem cell transplant (SCT) patients.
- Current prescribing practices exhibit significant variation in frequency, duration, and route of administration.
- This variability impacts overall treatment costs.
Purpose of the Study:
- To analyze cost efficiencies related to i.v. ondansetron use in pediatric SCT.
- To identify specific practice patterns contributing to high costs.
- To propose changes for cost reduction without affecting efficacy.
Main Methods:
- Retrospective analysis of 36 patients undergoing 41 SCTs in 1995.
- Pharmacy data on material and preparation costs for i.v. ondansetron.
- Examination of frequency, duration, and route of administration effects on cost.
Main Results:
- 498 days of ondansetron administration cost $49,083.
- One-third of patients received once-daily dosing despite evidence of equivalent efficacy with divided doses, indicating potential for 28% savings.
- Capping duration to 7-10 days could save 48-60%; switching to oral administration could save 67%.
Conclusions:
- Significant cost reductions are achievable through simple modifications in ondansetron prescribing practices.
- Standardizing dosing interval, route, and duration can lead to substantial savings.
- These changes can be implemented without compromising antiemetic efficacy or patient access.
Abstract:
We studied the practice patterns regarding intravenous (i.v.) ondansetron in children receiving stem cell transplants (SCT) at The Children's Hospital, Boston to identify cost efficiencies. The pharmacy provided information on material and preparation costs on 36 patients who received i.v. ondansetron during 41 SCT in 1995. We examined the effects of frequency, duration, and route of administration on costs. There were 498 days of ondansetron administration costing $49,083 (95$). Tremendous variation existed in frequency and duration with one third receiving i.v. ondansetron once daily, despite published evidence of equivalence of once a day and divided dosing. A switch to once daily i.v. dosing for all patients would have resulted in >/=28% savings. The median duration of use was 11 days (range 1-48); placing a cap for 7-10 days based on the length of SCT conditioning regimens, would produce savings of 48-60% over current use. By shifting administration route from i.v. to oral, a savings of 67% over current use, without a cap on duration, would be realized. Identifying areas for cost savings can be achieved after thorough analysis of all the component costs. We demonstrated that significant cost reductions could be realized by simple changes in prescribing practices without jeopardizing efficacy. These savings are achieved by standardizing dosing interval, route of administration and duration of treatment without altering daily dosage or access to an effective antiemetic. Bone Marrow Transplantation (2000) 25, 553-557.