Making moves: Transitioning R-EPOCH to the ambulatory setting

Area of Science:

• Oncology
• Healthcare Management
• Pharmacoeconomics

Background:

• Ambulatory chemotherapy administration offers benefits to patients and healthcare systems.
• The R-EPOCH (rituximab, etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) regimen is commonly administered inpatient.
• Transitioning R-EPOCH to an ambulatory setting presents an opportunity for cost savings and improved efficiency.

Purpose of the Study:

• To develop a guideline for transitioning R-EPOCH chemotherapy from inpatient to ambulatory administration.
• To assess the institutional benefits, including reduced inpatient bed days and financial impact, of ambulatory R-EPOCH administration.

Main Methods:

• A single-center, retrospective analysis of inpatient R-EPOCH administration (January 2013-December 2015) informed guideline development.
• The study involved creating medication use guidelines for ambulatory R-EPOCH administration.
• Multidisciplinary collaboration was essential for developing a comprehensive approach to outpatient chemotherapy administration.

Main Results:

• A total of 147 R-EPOCH cycles were administered to 42 patients, with 107 cycles given inpatient and 40 outpatient.
• Ambulatory R-EPOCH administration resulted in a 53% reduction in drug acquisition costs and a 30% reduction in direct costs.
• Projected annual savings include 360 inpatient bed days and approximately $650,000, with 12 patients eligible for ambulatory R-EPOCH annually.

Conclusions:

• Transitioning R-EPOCH to an ambulatory setting is a feasible strategy to decrease inpatient bed days and healthcare expenditures.
• Successful transition requires multidisciplinary collaboration to ensure consistent support for ambulatory administration.