Cancer Immunotherapy Stewardship - Cost-Neutral, Patient-Centered Dosing to Increase Infusion Center Efficiency

Area of Science:

• Oncology
• Pharmacoeconomics
• Health Services Research

Background:

• Pembrolizumab is a significant healthcare expenditure, with current fixed dosing potentially leading to overuse and increased costs.
• Existing dosing strategies may not be the most time-efficient or cost-effective for healthcare systems or convenient for patients.
• The shift towards personalized and optimized dosing regimens is a growing trend in cancer care.

Purpose of the Study:

• To develop and evaluate an immunotherapy stewardship initiative to optimize pembrolizumab dosing at a Veterans Affairs medical center.
• To promote the adoption of a 4 mg/kg every-6-weeks dosing schedule for pembrolizumab.
• To assess the impact of the initiative on drug costs, utilization, and patient time savings.

Main Methods:

• Implementation of a stewardship initiative from July 2024 to June 2025, incorporating dose banding and electronic medical record (EMR) order sets.
• Pharmacist-led education to guide prescribers towards the every-6-weeks dosing option.
• Quarterly audit feedback to reinforce adoption and track prescribing trends, drug utilization, and cost savings.

Main Results:

• The every-6-weeks dosing option for pembrolizumab monotherapy increased from 60% to 80% over the 12-month intervention period.
• The initiative was associated with approximately $296,000 in averted drug costs, capturing over 90% of modeled potential savings.
• More than 450 hours of healthcare contact time were averted, equivalent to approximately 6 hours saved per patient annually.

Conclusions:

• Pragmatic tools such as dose banding, EMR redesign, pharmacist involvement, and feedback loops can significantly enhance the efficiency of oncology drug administration.
• The stewardship initiative demonstrated a successful model for balancing value, efficiency, and patient-centered care in cancer treatment.
• This replicable framework offers a pathway for health systems to optimize immunotherapy use and reduce healthcare spending without compromising care quality.