Results of a pharmacy driven erythropoietin stimulating agent dispensing and monitoring program at a community hospital

Purpose:  Inappropriate use of erythropoietin stimulating agents (ESA) has led to an increase in thromboembolic events for all indications, also to, shortened overall survival and/or increased risk of tumor progression. Posing a significant increase in hospital expenditures from an economic perspective.  The purpose of this study is to document the results of a pharmacy driven, ESA dispensing and monitoring program.

Methods: A prospective interventional IRB reviewed study of patients receiving darbepoetin alpha, formulary ESA at Baptist Hospital, from December 2011 to May 2012.  An MEC (medical executive committee) approved protocol based on predefined hemoglobin levels consistent with FDA label for darbepoetin was utilized.  Patients were reviewed for indication, dose, and laboratory parameters. Doses were adjusted, dispensed, held per protocol or pharmacist recommendation. Interventions were documented in SENTRI-7, clinical pharmacy surveillance program. Primary objective is to assess the impact of pharmacist interventions, including the total number of doses held per protocol and dose adjusted per recommendation.  Secondary endpoint is cost savings from prevention of adverse drug events and decrease in medication costs.

Results: Total of 79 pharmacist interventions were completed during the study period.  Overall 24 doses of darbepoetin were not administered based on predefined hemoglobin levels, per protocol. The remaining 55 interventions were dose adjustment recommendations, resulting in an estimated annual medication cost savings of $34,314. Cost avoidance of $20,800 was estimated due to the prevention of adverse drug events.  Overall, there was 31.6% reduction in the prescribing of darbepoetin from previous years, which can be partially attributed to pharmacist involvement in ESA dispensing and monitoring.

Conclusion:   Over use of ESAs has lead to FDA changes, consisting of hemoglobin thresholds for ESA administration.  Pharmacy driven program helps promote the appropriate use of ESAs and may potentially prevent adverse drug events. Also can provide cost savings by decreasing over utilization.