Standardized Dose Rounding for Infliximab Reduces Costs, Study Demonstrates

Infliximab accounts for substantial drug spending in the United States, and dose rounding has become a common practice at many facilities as a way to avoid wasting vials that have only been partially used. However, many institutions do not have standardized approaches to rounding doses, and because infliximab requires a weight-based dose, rounding becomes even more complex.

A research team from the Englewood Hospital and Medical Center in Englewood, New Jersey, recently published a paper on experience in their clinic, where they compared costs among nonstandardized dose-rounding practices, standardized dose-rounding practices, and theoretical exact dosing for infliximab.

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The researchers performed a retrospective chart review from October 2016 to March 2017, and included patients receiving infliximab for inflammatory bowel disease in the center’s outpatient infusion clinic. A total of 69 patients received nonstandardized dose rounding, and 45 patients received standardized dose rounding (using a chart with specified measures), during this period.

The nonstandardized group was treated with a total of 773 vials over an approximate 3-month period. Had this group been treated using the standardized dose-rounding chart, the authors estimate that 40 vials of infliximab could have been saved, producing a cost savings of $44,472. If the savings were consistent over a year, assuming that 40 patients receive infliximab each month, using the standardized chart could produce a cost savings of $104,640 per year at the center.

Using standardization in dose rounding led to slightly longer time from weight measurement to order verification, but the minor difference in time was, the investigators said, not practically meaningful. Greater experience with standardized rounding could also reduce the time to order verification.

The authors concluded that dose rounding helped the center to avoid unnecessary costs, and that using a standard method could help to improve pharmacy workflow.

Reference

Park JJ, Boutillier L, Cruz JE, Joung G, Nemeth J. Effect of standardized infliximab dose rounding on an outpatient infusion center. J Manag Care Spec Pharm. 2018;24(10):1028-1033. doi: 10.18553/jmcp.2018.24.10.1028.