title: Improvement in appropriate utilization of recombinant human erythropoietin pre- and post-implementation of a required order form.
abstract: BACKGROUND
  Erythropoietin stimulating agents (ESAs) are high-cost medications that have a significant impact on many pharmacy budgets. Recently, ESAs have received stronger safety warnings and reimbursement has been curtailed by third-party payers including the Centers for Medicare and Medicaid Services. For these reasons, many hospitals are developing strategies to optimize their use. A required order form with acceptable indications and dosing was implemented at an academic medical center in an attempt to improve dosing and appropriate utilization of ESAs.
  
  
  OBJECTIVE
  To determine whether implementation of a required order form increased appropriate use and/or decreased total utilization of recombinant human erythropoietin (rHuEPO).
  
  
  METHODS
  This was a retrospective cohort study of rHuEPO utilization for 4 months pre- and 6 months post-implementation (April 2008-January 2009).
  
  
  RESULTS
  Implementation of a required order form for rHuEPO resulted in significantly fewer patients receiving inappropriate doses of rHuEPO (51.3% vs 19.2%, p < 0.001). The number of patients treated, adjusted to hospital census, was also reduced after implementation of the order form (0.003 vs 0.004 pts./average pt. days, p = 0.03). Annual spending for rHuEPO was reduced by 47% during 2008 despite an increased acquisition cost.
  
  
  CONCLUSIONS
  Implementation of a required order form with evidence-based dosing recommendations can be an effective strategy to improve appropriate utilization of rHuEPO.
authors.affiliation: Creighton University Medical Center, Omaha, NE 68131, USA. tburns@creighton.edu
authors.forename: Tammy L
authors.initials: TL
authors.lastname: Burns
authors.forename: Brenna A
authors.initials: BA
authors.lastname: Ferry
authors.forename: Mark A
authors.initials: MA
authors.lastname: Malesker
authors.forename: Lee E
authors.initials: LE
authors.lastname: Morrow
authors.forename: Anne L
authors.initials: AL
authors.lastname: Bruckner
authors.forename: Debra L
authors.initials: DL
authors.lastname: Lee
mesh_terms: D015331:Cohort Studies; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D004921:Erythropoietin / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011994:Recombinant Proteins; D012189:Retrospective Studies
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin