title: Impact of clinical oral chemotherapy program on wastage and hospitalizations.
abstract: OBJECTIVE
  The oral chemotherapy cycle management program (CMP) provides clinical management support to patients receiving certain oral chemotherapies. The CMP includes a dose-monitoring (ie, split-fill) plan for early identification and management of adverse effects. If serious adverse effects are identified mid cycle, the remainder of the monthly supply is withheld, thus avoiding potential waste associated with early therapy discontinuation. This study investigated medication wastage and estimated potential cost savings for patients who were enrolled in the CMP, as compared with those who were not enrolled in the program.
  
  
  METHODS
  Retrospective test-control study.
  
  
  METHODS
  Patients whose oral chemotherapy was initiated between June 2008 and February 2010 and who were enrolled in the CMP were included as the test group. Patients whose oral chemotherapy was initiated between June 2007 and May 2008 and who were not part of the CMP were included as the control group.
  
  
  RESULTS
  Medication wastage associated with early therapy discontinuation was found to be lower in the CMP group. Approximately 34% of patients in the CMP group could have avoided medication wastage if split-fill plans had been available, potentially realizing savings of approximately $934.20 per patient. Linear probability regression models showed that the CMP group had a 2.9% probability for reduction in hospital admissions (P <.05), resulting in additional savings of approximately $440.00 per patient. Combined savings resulting from reduced wastage and hospital admissions was approximately $1374 per patient.
  
  
  CONCLUSIONS
  Dose-monitoring programs such as the CMP effectively reduce wastage and serious adverse effects associated with oral chemotherapeutic agents, realizing potential cost savings for both payers and patients.
authors.affiliation: Nikhil.Khandelwal@walgreens.com
authors.forename: Nikhil
authors.initials: N
authors.lastname: Khandelwal
authors.forename: Ian
authors.initials: I
authors.lastname: Duncan
authors.forename: Tamim
authors.initials: T
authors.lastname: Ahmed
authors.forename: Elan
authors.initials: E
authors.lastname: Rubinstein
authors.forename: Cheryl
authors.initials: C
authors.lastname: Pegus
mesh_terms: D000284:Administration, Oral; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D017046:Cost Savings / Q000379:methods; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008506:Medical Waste / Q000191:economics* / Q000517:prevention & control; D009369:Neoplasms / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents; D008506:Medical Waste