Investigators have found that millions of dollars could be saved annually across the Veterans Health Administration by reconsidering how immune checkpoint inhibitors are delivered, according to a new study published by Bryant et al in Health Affairs. The findings suggested that if vials of immune checkpoint inhibitors intended for a single patient are shared across patients, then physicians may be able to deliver customized doses while also reducing drug waste and costs—a concept that could be applied at all cancer centers nationwide.
Background
Immune checkpoint inhibitors were initially tested and approved at weight-based doses but then moved to one-size-fits-all flat doses, in part to reduce drug waste.
“Administering drugs in flat one-size-fits-all dosages is predictable and allows for single-use vials with less drug material being discarded. This gives the appearance of less waste to the payer, but it conceals the fact that excess drug amounts may be administered to the patient, relative to what they need—which ultimately may be increasing usage and drug spending,” explained senior study author Garth W. Strohbehn, MD, MPhil, Clinical Assistant Professor of Hematology and Oncology in the Department of Medicine at the University of Michigan Regal Comprehensive Cancer Center and an early career research scientist at the U.S. Department of Veterans Affairs (VA) Ann Arbor Center for Clinical Management and Research.
Study Methods and Results
In the new study, the investigators used data from the Veterans Health Administration to identify the health records of patients who received at least one dose of any type of immune checkpoint inhibitor from a VA medical center in 2021 and create a simulation of how the drugs could be better administered. This included using weight-based doses and combining single-use vials across multiple patients rather than discarding any extras.
The Veterans Health Administration spends hundreds of millions of dollars per year on immune checkpoint inhibitors. However, the researchers discovered that combining weight-based dosing and single-use vial sharing within each VA hospital’s pharmacy would reduce immune checkpoint inhibitor spending by 14%.
Conclusions
“Evidence suggests that flat and weight-based dosing are equally effective [at] treating cancer. In an era of ever-rising drug prices and aging populations, adopting stewardship measures could markedly improve the cost-effectiveness of cancer care in our country,” concluded lead study author Alex Bryant, MD, MAS, Assistant Professor of Radiation Oncology at Michigan Medicine.
Disclosure: The research in this study was funded by the Lung Precision Oncology Program, LUNGevity, the Department of Veterans Affairs, the Melanoma Research Alliance, the National Cancer Institute, and the Breast Cancer Research Foundation. For full disclosures of the study authors, visit healthaffairs.org.
