Pharmacy 483 MUE Cost Effective Medication Utilization Quality - - PowerPoint PPT Presentation

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Pharmacy 483 MUE Cost Effective Medication Utilization Quality - - PowerPoint PPT Presentation

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Pharmacy 483 MUE Cost Effective Medication Utilization Quality Cost Improvement Management February 14, 2006 Janet Kelly, Pharm.D . Outcomes & Cost Management UWMC Provide pharmacy leadership for medication related outcomes

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Cost Effective Medication Utilization MUE Quality Improvement Cost Management

Pharmacy 483

February 14, 2006

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Janet Kelly, Pharm.D.

  • Outcomes & Cost Management UWMC
  • Provide pharmacy leadership for

medication related outcomes

Pharmacy & Therapeutics Treatment guidelines/criteria for use

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Steve Riddle

  • Quality Improvement and Medication Utilization

Lead “Right drug for the right patient every time”

  • Work with administration and clinical staff

(physicians, pharmacists) to develop care processes for specific conditions and/or medications.

  • Examples: ACE inhibitors in myocardial infarction

and heart failure; use of most cost-effective agents in depression; treatment of chronic pain

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Goals of the Presentation

  • Understand the basics of continuous quality

improvement (CQI) and how it is used to achieve optimal patient outcomes.

  • Understand the role of Medication Utilization

Evaluation (MUE) in the CQI process.

  • Understand the basics of cost effectiveness

evaluations.

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Continuous Quality Improvement

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  • Retrospective/Prospective
  • Is utilization of the drug appropriate?
  • compared to goals

(criteria for use and/or treatment guidelines

  • Provides necessary data for CQI

process

Key Terms

Medication Utilization Evaluation

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Formulary

  • List of Drugs Which May Be Prescribed
  • Developed by the P&T Committee based on:

Safety Efficacy Cost Effectiveness

Key Terms

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Cost Effective Therapy

Least expensive therapy which provides the desired outcome

Medication Cost

Monitoring Costs (labs/ office visits/etc) Adverse Effect Costs

Very slippery concept – difficult to quantify

Convenience

Individual Patient Preference

Key Terms

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Cost Effective Calculation

Lexus ES 330 Hyundai Sonata V6 Initial Cost $35,000 26 mpg Initial Cost $21,000 24 mpg

Cost effectiveness evaluation must also include:

Maintenance Cost Life Span of the Car

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Cost Effective Calculation (Cont)

Lexus ES 330 Hyundai Sonata V6 Life span = 150,000 miles Maintenance cost = $0.3 per mile Life span = 96,000 miles Maintenance cost = $0.26 per mile Total Cost = $91,538 Cost per mile = $0.61 Total Cost = $53,960 Cost per mile = $0.56

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Antidepressant Cost Effectiveness Comparison

ZOLOFT AMITRIPTYLINE Acquisition Cost Monitoring Cost Cost of Adverse Effects True Cost of Zoloft Acquisition Cost Monitoring Cost Cost of Adverse Effects True Cost of Amitriptyline VS. Comparative Info Comparative Info Analysis Model Cost Effectiveness Ratio

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Evaluation of IVIG Utilization

  • What is IVIG?
  • Intravenous preparation of immune globulins

(antibodies) derived from pool plasma

  • What is it used to treat?
  • Only 5 FDA indications
  • Dozens of off-label indications

(many with little or no data to support use)

  • Why evaluate?
  • Limited resource
  • Safety Issues
  • Cost (2 million per year)
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IVIG MUE Criteria

Reviewed charts for all patients that received IVIG at UWMC/HMC for a 2 month period Indication for IVIG Dose of IVIG given Duration of IVIG therapy Prescribing Service Adverse Effects Attributed to IVIG

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Indications for IVIG

Results

9% 27% 21% 43% FDA labeled Off label with support Off label without support Unable to Determine

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Dosing Regimen of IVIG

Results

22% 8% 70% Appropriate Inappropriate Unclear

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IVIG Prescribing Service

Results

% of Total IVIG Cost

32% 12% 18% 13% 25% HemOnc Transp Medicine Neuro Burns

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Adverse Effects

Results

# of Patients having an ADR

1 2 3 4 Infusion Reaction Nephropathy Other # of Patients

2.9%* 4.2%* 1.4%* * % of all patients treated with IVIG during the study period (n=70)

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Assess the Results

We have a problem!

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Plan & Design Multidisciplinary Task Force

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Goals

  • Need to know what IVIG is being prescribed for
  • in 43 % of patients it was unclear
  • Who are the primary prescribers?
  • Provide education for prescribers regarding:
  • Appropriate indications
  • Appropriate dosing
  • Product selection
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Plan for Accomplishing Goals

  • Addition of a sucrose free IVIG product to

formulary

  • Sucrose is associated with nephropathy
  • Guidelines for who should receive
  • Development of an IVIG order form
  • Check boxes for indications
  • Dosing recommendations
  • Product selection
  • Administration/Monitoring
  • Premedications
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IVIG Order Form

I. Select Diagnosis/Indication for IVIG FDA Indications (with dosing recommendations) Off Label Indications (with dosing recommendations) II. Select IVIG Product Standard Product Sucrose Free Product III. Indicate Dose & Frequency Give grams of IVIG (Select Product Above) every

(specify frequency) for a total of

doses

(specify # of doses to be given).

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Implementation

  • f IVIG Order Form
  • Approval of P&T Committee
  • Forms Committee Approval
  • Printing & Distributing
  • Education
  • Pharmacist Education
  • Physician Education
  • Nursing Education
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Re-evaluate

Prospective MUE using order forms

  • Tabulate results in 3-6 months
  • Did the form improve utilization of IVIG?
  • Look at incidence of ADR
  • Did adding sucrose free product decrease

incidence of nephropathy?

  • Was it cost effective?
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Repeat the Cycle

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Formulary and Financial Impact Evaluation

Weighted Evaluation of: Safety Efficacy Financial Impact

Add to formulary Do NOT Add to formulary

Advantage NO Advantage

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Pregabalin (LyricaR)

♦ Structural analog of GABA

  • GABA is an inhibitory neurotransmitter
  • Similar to Gabapentin (NeurontinR)

♦ Indications

  • Partial Seizures
  • Neuropathic Pain

♦ Therapeutic Advantage?

  • Safety
  • Efficacy
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Steps in an Financial Impact Evaluation

  • 1. Determination of Total Cost
  • 2. Determination of Reimbursement
  • 3. Calculation of Potential Revenue

Financial Impact Evaluation Cost Effectiveness

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Financial Impact Evaluation

Pregabalin vs. Gabapentin Determination of Costs:

Drug Acquisition Monitoring, ADRS, & Convenience Drug Administration Cost

Clinic vs. Self Administered

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Financial Impact Evaluation

Pregabalin vs. Gabapentin Determination of Reimbursement: HOSPITAL

  • DRG or Capped

Reimbursement AMBULATORY

  • Insurance Mix

(DSHS/Medicaid, Medicare, Private, Indigent)

  • Insurer Formularies
  • Patient Responsibilty

(co-pays)

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Financial Impact Evaluation

Pregabalin vs. Gabapentin Calculation of Profit Margin:

Reimbursement Total Cost

  • =

Profit Margin

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Appropriate Utilization

♦Clinical Criteria for Use ♦Minimizing Economic Impact

  • Anticipated Usage

Treatment Guidelines Use Restrictions VS.. Education

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  • 3. P& T

evaluation – add or not add to formulary 1. Clinical Evaluation 2. Anticipated Usage/Economic Impact

  • 4. Education

Guidelines vs. Restriction 5 . M U E E c

  • n
  • m

i c I m p a c t

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Questions?