Dose Rounding Can Reduce Drug Waste Costs Associated With Reference, Biosimilar Bevacizumab

Dose rounding of biological anti-neoplastic agents, such as reference bevacizumab (Avastin) and its FDA-approved biosimilars (n = 4), was shown to offset the impact of drug waste and reduce the total cost of care for value-based programs, according to a recent analysis of Oncology Care Model (OCM) practices.

The results were presented at the American Society of Clinical Oncology Annual Meeting, which took place from June 2 to June 6, 2023, in Chicago, Illinois.

The OCM was a 6-year long Medicare value-based care program that offered practices rewards for decreasing total cost of care (TCOC) compared with a benchmark price without impacting the ability to maintain high-quality cancer care. Drug waste from partially used single-dose vials of expensive biologics is considered to be a leading contributor to TCOC expenditures for payers.

Dose rounding (DR), whereby doses of anticancer treatments are rounded up or down between 5% and 10% of the ordered dose in line with recommendations from Hematology Oncology Pharmacists Association and endorsed by the National Comprehensive Cancer Network, is a common approach to mitigate the impact of drug waste.

In 2018, many OCM practices adopted a DR program for biologic agents as a strategy to reduce drug waste and TCOC. However, whether the strategy worked remained to be seen. The researchers assessed claims data for 14 practices in The US Oncology Network participating in the OCM. The data included drug administration data for reference bevacizumab and bevacizumab biosimilars (Vegzelma, Mvasi, Zirabev, and Alymsys) to evaluate drug waste, total dose, TCOC, DR, and the financial impact of drug waste reduction on TCOC from 2017 to 2021.

Prior to implementing DR, on average 5.3% (range, 4.6% to 5.5%) of the total dose of bevacizumab products was wasted, with about 25% of bevacizumab administrations having wasted over 10% of the total dose.

A DR initiative led to a reduction of waste for 30% of the total number of bevacizumab administration across all 14 practices. As a result of DR, bevacizumab drug waste decreased by 55% to an average 2.5% (range, –2.3% to 2.7%) of the total dose in 2021. The decreased waste resulted in TCOC reduction of about $100 per member episode per month (0.97% of TCOC) for episodes with a bevacizumab administration.

The highest waste reduction was seen in situations where the patient was receiving bevacizumab as a treatment for gastrointestinal cancer (colon, rectal, anal, gastroesophageal, or pancreatic) compared with other cancer types (lung, brain, ovarian, etc). Also, there was about a 50% reduction in cases where bevacizumab drug waste were over 10% of the total dose.

The authors noted that a similar DR approach could be adopted for other high-cost originator and biosimilar biologic agents where drug waste results from partial use of single dose vials.

Reference

Indurlal P, Alam N, Garey JS, Wilfong LS. Dose rounding bevacizumab and its biosimilars to reduce drug waste in the oncology care model in a community oncology network. Poster presented at: American Society of Clinical Oncology Annual Meeting; June 2-6, 2023; Chicago, Illinois. Poster 1529.