Clinical Outcomes of a Pharmacy-Led Blood Factor Stewardship Program.
To report the results of a pharmacist-directed blood factor stewardship program targeting off-label utilization designed to limit use to established organizational guidelines in high-risk populations. Prospective evaluation of recombinant factor VIIa and prothrombin complex concentrate orders beginning June 2013 through May 2014 and a matched retrospective cohort from June 2012 to May 2013. Matched cohorts were evaluated for 28-day mortality, change in international normalized ratio (INR), adverse events, concurrent blood product use, and cost savings. Forty-two orders for blood factor were ordered between June 2013 and May 2014, 70 orders in the year before (N = 112). Twenty eight-day mortality was not different between the cohorts: 53.9% versus 50% (P = 0.77). Blood factor use with underlying liver failure and active bleeding was strongly associated with 28-day mortality: odds ratio (95% confidence interval), 2.9 (1.5-7.14) and 2.91 (0.01-2.91), respectively. Blood products dispensed increased over the year with plasma products the most significant (1 vs. 4 P = 0.004). All other clinical outcomes were nonsignificant. An annual cost savings of $375,539 was achieved, primarily through a significant reduction in recombinant factor VIIa and avoidance in high-risk patients. Use of off-label blood factors can be controlled through a pharmacist-led stewardship program. Twenty eight-day mortality was not different between the 2 cohorts; however, identification of risk factors for death associated with blood factor use allows for restriction in high-risk populations, creates a discussion of futile care, and yields cost savings.
Department of Pharmacy, Indiana University Health Simon Cancer Center, Indianapolis, IN.
Anne O
AO
Trueg
Christopher
C
Lowe
Patrick J
PJ
Kiel
D000328:Adult; D000368:Aged; D001779:Blood Coagulation Factors; D017046:Cost Savings; D017723:Drug Utilization Review; D015942:Factor VIIa; D006470:Hemorrhage / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D019934:International Normalized Ratio; D008875:Middle Aged; D056687:Off-Label Use / Q000592:standards; D010593:Pharmaceutical Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D010595:Pharmacists / Q000458:organization & administration* / Q000592:standards; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011994:Recombinant Proteins; D012189:Retrospective Studies
D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; C103587:recombinant FVIIa; D015942:Factor VIIa