Comparison of Pegfilgrastim Prescribing Practice to National Guidelines at a University Hospital Outpatient Oncology Clinic

Geralyn E. Waters, Patricia Corrigan, Mandy Gatesman, Thomas J Smith

Research output: Contribution to journalArticle

Abstract

Purpose: Pegfilgrastim reduces the risk of febrile neutropenia (FN) and is indicated as primary prophylaxis when the risk of FN approaches 20% in each chemotherapy cycle. There have been few reports evaluating the appropriate use of pegfilgrastim in comparison with published guidelines. We sought to determine possible over-prescribing as a way to maintain quality and reduce cost. Methods: A retrospective medical record review was performed to determine whether pegfilgrastim was used appropriately in the primary prophylaxis of FN in chemotherapy regimens with less than 20% risk of FN. Patients were identified by means of administrative records, and data were collected from the electronic medical record at an academic cancer center outpatient clinic serving approximately 13,000 patients per year. Results: Two hundred ninety-two patients were identified, of whom 124 were initially evaluated and 88 were included. Thirty-three patients (37%) had no risk factors, and 20 (22%) had one risk factor that would justify pegfilgrastim use with low-or intermediate-risk regimens. The most common cancer diagnosis of patients with zero or one risk factor was lymphoma, and the most common regimens with over use of pegfilgrastim were doxo-rubicin-bleomycin-vinblastine-dacarbazine (ABVD) and ritux-imab-cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP). One hundred eighty-four pegfilgrastim doses (46%) were classified as avoidable. The cost to the health system for unnecessary drug use was $712,264 in 1 year. Conclusion: At one institution, approximately one half of all primary prophylaxis pegfilgrastim was not indicated per published guidelines. This represents an excellent opportunity to change prescribing practices to reduce costs without harming patients.

Original languageEnglish (US)
Pages (from-to)203-206
Number of pages4
JournalJournal of Oncology Practice
Volume9
Issue number4
DOIs
StatePublished - Jul 2013

Fingerprint

Hospital Outpatient Clinics
Febrile Neutropenia
Guidelines
Inappropriate Prescribing
Costs and Cost Analysis
Drug Therapy
Dacarbazine
Vinblastine
Electronic Health Records
Bleomycin
Vincristine
Prednisone
Ambulatory Care Facilities
pegfilgrastim
Health Care Costs
Doxorubicin
Cyclophosphamide
Medical Records
Lymphoma
Neoplasms

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

Comparison of Pegfilgrastim Prescribing Practice to National Guidelines at a University Hospital Outpatient Oncology Clinic. / Waters, Geralyn E.; Corrigan, Patricia; Gatesman, Mandy; Smith, Thomas J.

In: Journal of Oncology Practice, Vol. 9, No. 4, 07.2013, p. 203-206.

Research output: Contribution to journalArticle

@article{fa63a8e1db90427285106644ed85bdb0,
title = "Comparison of Pegfilgrastim Prescribing Practice to National Guidelines at a University Hospital Outpatient Oncology Clinic",
abstract = "Purpose: Pegfilgrastim reduces the risk of febrile neutropenia (FN) and is indicated as primary prophylaxis when the risk of FN approaches 20{\%} in each chemotherapy cycle. There have been few reports evaluating the appropriate use of pegfilgrastim in comparison with published guidelines. We sought to determine possible over-prescribing as a way to maintain quality and reduce cost. Methods: A retrospective medical record review was performed to determine whether pegfilgrastim was used appropriately in the primary prophylaxis of FN in chemotherapy regimens with less than 20{\%} risk of FN. Patients were identified by means of administrative records, and data were collected from the electronic medical record at an academic cancer center outpatient clinic serving approximately 13,000 patients per year. Results: Two hundred ninety-two patients were identified, of whom 124 were initially evaluated and 88 were included. Thirty-three patients (37{\%}) had no risk factors, and 20 (22{\%}) had one risk factor that would justify pegfilgrastim use with low-or intermediate-risk regimens. The most common cancer diagnosis of patients with zero or one risk factor was lymphoma, and the most common regimens with over use of pegfilgrastim were doxo-rubicin-bleomycin-vinblastine-dacarbazine (ABVD) and ritux-imab-cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP). One hundred eighty-four pegfilgrastim doses (46{\%}) were classified as avoidable. The cost to the health system for unnecessary drug use was $712,264 in 1 year. Conclusion: At one institution, approximately one half of all primary prophylaxis pegfilgrastim was not indicated per published guidelines. This represents an excellent opportunity to change prescribing practices to reduce costs without harming patients.",
author = "Waters, {Geralyn E.} and Patricia Corrigan and Mandy Gatesman and Smith, {Thomas J}",
year = "2013",
month = "7",
doi = "10.1200/JOP.2012.000662",
language = "English (US)",
volume = "9",
pages = "203--206",
journal = "Journal of Oncology Practice",
issn = "1554-7477",
publisher = "American Society of Clinical Oncology",
number = "4",

}

TY - JOUR

T1 - Comparison of Pegfilgrastim Prescribing Practice to National Guidelines at a University Hospital Outpatient Oncology Clinic

AU - Waters, Geralyn E.

AU - Corrigan, Patricia

AU - Gatesman, Mandy

AU - Smith, Thomas J

PY - 2013/7

Y1 - 2013/7

N2 - Purpose: Pegfilgrastim reduces the risk of febrile neutropenia (FN) and is indicated as primary prophylaxis when the risk of FN approaches 20% in each chemotherapy cycle. There have been few reports evaluating the appropriate use of pegfilgrastim in comparison with published guidelines. We sought to determine possible over-prescribing as a way to maintain quality and reduce cost. Methods: A retrospective medical record review was performed to determine whether pegfilgrastim was used appropriately in the primary prophylaxis of FN in chemotherapy regimens with less than 20% risk of FN. Patients were identified by means of administrative records, and data were collected from the electronic medical record at an academic cancer center outpatient clinic serving approximately 13,000 patients per year. Results: Two hundred ninety-two patients were identified, of whom 124 were initially evaluated and 88 were included. Thirty-three patients (37%) had no risk factors, and 20 (22%) had one risk factor that would justify pegfilgrastim use with low-or intermediate-risk regimens. The most common cancer diagnosis of patients with zero or one risk factor was lymphoma, and the most common regimens with over use of pegfilgrastim were doxo-rubicin-bleomycin-vinblastine-dacarbazine (ABVD) and ritux-imab-cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP). One hundred eighty-four pegfilgrastim doses (46%) were classified as avoidable. The cost to the health system for unnecessary drug use was $712,264 in 1 year. Conclusion: At one institution, approximately one half of all primary prophylaxis pegfilgrastim was not indicated per published guidelines. This represents an excellent opportunity to change prescribing practices to reduce costs without harming patients.

AB - Purpose: Pegfilgrastim reduces the risk of febrile neutropenia (FN) and is indicated as primary prophylaxis when the risk of FN approaches 20% in each chemotherapy cycle. There have been few reports evaluating the appropriate use of pegfilgrastim in comparison with published guidelines. We sought to determine possible over-prescribing as a way to maintain quality and reduce cost. Methods: A retrospective medical record review was performed to determine whether pegfilgrastim was used appropriately in the primary prophylaxis of FN in chemotherapy regimens with less than 20% risk of FN. Patients were identified by means of administrative records, and data were collected from the electronic medical record at an academic cancer center outpatient clinic serving approximately 13,000 patients per year. Results: Two hundred ninety-two patients were identified, of whom 124 were initially evaluated and 88 were included. Thirty-three patients (37%) had no risk factors, and 20 (22%) had one risk factor that would justify pegfilgrastim use with low-or intermediate-risk regimens. The most common cancer diagnosis of patients with zero or one risk factor was lymphoma, and the most common regimens with over use of pegfilgrastim were doxo-rubicin-bleomycin-vinblastine-dacarbazine (ABVD) and ritux-imab-cyclophosphamide-doxorubicin-vincristine-prednisone (R-CHOP). One hundred eighty-four pegfilgrastim doses (46%) were classified as avoidable. The cost to the health system for unnecessary drug use was $712,264 in 1 year. Conclusion: At one institution, approximately one half of all primary prophylaxis pegfilgrastim was not indicated per published guidelines. This represents an excellent opportunity to change prescribing practices to reduce costs without harming patients.

UR - http://www.scopus.com/inward/record.url?scp=84887113335&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84887113335&partnerID=8YFLogxK

U2 - 10.1200/JOP.2012.000662

DO - 10.1200/JOP.2012.000662

M3 - Article

C2 - 23942922

AN - SCOPUS:84887113335

VL - 9

SP - 203

EP - 206

JO - Journal of Oncology Practice

JF - Journal of Oncology Practice

SN - 1554-7477

IS - 4

ER -