Pharmacy Driven Chemotherapy and Monoclonal Antibody Dose-Rounding: A Cost-Savings Evaluation

2. Eris Tollkuci, PharmD, BCOP
Amanda Seddon, PharmD, BCPS, BCOP
Kathryn Schultz, PharmD, BCPS, BCOP
Becca Myers, PharmD
Brian Seyboth, PharmD, BCOP
Zach Click, PharmD

3. Published literature has demonstrated that implementation
of chemotherapy dose rounding protocols resulted in
estimated cost savings between tens of thousands to
millions of dollars for single institutions each year.
Dose rounding within 10% of the ordered dose is based on
the available literature as well as general consensus that it
will not negatively impact safety or efficacy.

4.  Each institution develop its own dose-rounding policy which
addresses both monoclonal antibodies and cytotoxic drugs.
 Institutional guidelines should be based on a COLLABORATIVE
interdisciplinary consensus.
 Each institution should also establish its own criteria for automatic
dose rounding, the allowable percentage, and the processes for
operationalizing and documenting any modifications to the original
prescribed dose.
 Exceptions to the policy should be determined a priori.
 Dose rounding represents a relatively simple cost-saving measure
that institutions can implement to reduce waste and healthcare costs.

5.  Approved by the Chemotherapy Subcommittee and the PNT
Committee
 Implemented July 2018
 Policy restrictions:
Inpatient setting
Adult patients
Chemotherapy and monoclonal antibodies

6. Pharmacokinetic-directed dosing (busulfan)
Clinical trial participants
Pediatric patients
Flat dose regimens
Procedural routes of administration (intrathecal,
intraventricular, intra-arterial, intra-vesicular, isolated limb
infusion)

7. 1. When evaluating chemotherapy orders, the
hematology/oncology pharmacist shall identify dose-
rounding opportunities utilizing Appendix A.
2. When an appropriate dose rounding opportunity is
identified, the order is adjusted and double checked at
the point of verification by the pharmacists.

11. Three medications^ were selected for review:
1. Melphalan
2. Rabbit antithymocyte globulin (Thymoglobulin, rATG)
3. Equine antithymocyte globulin (Atgam)
Location: 14E and 14W Tower
Timeframe: July 2018-March 2019
^Medications were selected based on cost and frequency of use. A future study will evaluate a more global impact of the dose
rounding policy on all chemotherapy agents and monoclonal antibodies combined.

12. Melphalan rATG Atgam
Number of patients where dose
rounding was incorporated
22 7 6
Number of chemotherapy doses
rounded down
26 19 23
Range of dose rounding (%) 1-7.4 1-7 0.3-6.9

13. Melphalan rATG Atgam
Number of vials saved
as a result of dose
rounding
26 19 23
Cost savings ($) 10,972.00 13,562.96 212,638.91
TOTAL COST SAVINGS = $237,173.87
over an 8 month time period