Impact of an Infliximab Dose Rounding Protocol on Vial Usage and

Cost Savings in Adults at a Large Academic Medical Center

Rachel Meilan, PharmD Candidate
and Katherine E. Duprey, PharmD, BCACP, CDOE,
A,B CVDOEB

A. University of Rhode Island College of Pharmacy B. Lifespan, Rhode Island Hospital

Background Statistical Analysis Results

• Infliximab and its biosimilar products are • Mean differences with 95% confidence limits (95%CLs) using paired t-
Table 1. Effect of dose rounding protocol on vials used
chimeric monoclonal antibodies that bind to tests were calculated to compare outcomes after versus before the Difference Difference
human tumor necrosis factor alpha. protocol was implemented. Pre- Post-
Difference in number accounting for
• Infliximab is dosed according to patient weight protocol protocol
(Vials) of infusion variance
and indicated inflammatory condition.1 Patient Population (vials) (vials)
infusions (vials)
• Infliximab was responsible for the highest
Infliximab 1521 1480 - 41 1 - 35
national drug expenditure in 2018. 2 Characteristics
Patients who received infusion at
• Opportunity exists to reduce drug waste and Age at study start (years) specified center
Infliximab-
1208 1143 - 65 5 - 35
cost by establishing a dose-rounding protocol. (n=629)
dyyb
Mean (SD) 41 (19)

Objective Median (Q1, Q3) 37 (23,56)

Under 18 years old
Overall 2729 2623 - 106 6 - 70
Age range 18-90 (n=150)
• This retrospective cohort study aims to assess if Table 2. Average milligrams used per infusion per person
the use of a dose rounding protocol results in a Female sex (n, %) 181 (54)
Post-
reduction in vial usage and thus a reduction in Diagnosis (n, %) ≥ 18 years old Pre-protocol Mean Difference
protocol
cost with infliximab and biosimilar products. Inflammatory Bowel (n=479) (mg)
(mg)
95%CI X-Y, p-value=Z
243 (72.1)
Disease -1.9 (95%CLs, -5.1, 1.4),
Methods Rheumatologic Disease 82 (24.3) Did not receive infusion pre
Infliximab 557.5 559.4
p=0.2571
AND post-protocol (n=103) -6.2 (95%CLs, -10.1, -2.2),
• Subjects were identified through a query of the Dermatologic
7 (2.1) Infliximab-dyyb 562.7 568.9
electronic medical record. Disease p=0.0024
-3.7 (95%CLs, -6.2, -1.2),
• Inclusion Criteria: Misc. 5 (1.5) Received infusion pre AND post- Overall 559.7 563.3
protocol p=0.004
• Adult patients (age ≥ 18) Drug Used (n, %) (n=376)
• Received the same infliximab originator or
biosimilar product pre- and post-protocol Infliximab 198 (58.8)
Rounded Dose Pre-
Conclusions
• Received infusion at our institution’s largest Infliximab-dyyb 139 (41.3) protocol
• Overall savings: 70 vials within a 3-month period
(n=39)
infusion center Number of vials per • Accounts for a difference of 6 infusions pre- versus post-protocol
• Pre-protocol inclusion period: 1/9/21 - 3/8/21 infusion, mean (SD)
and average of approximately 6 vials used per infusion
• Post-protocol inclusion period: 3/9/21 - 7/30/21 Pre-Protocol 6 (5)
Study Population
(n=337) • Utilization of a dose rounding protocol resulted in an increase in
• Exclusion Criteria: Post-Protocol 6 (5) milligrams administered per infusion per person.
• Patients less than 18 years old • Utilization of an infliximab dose rounding protocol resulted in cost-
Inflectra (infliximab-
• Did not receive infusion pre AND post protocol Weight, kg, mean (SD) Remicade (infliximab)
dyyb) savings.
• Data points collected: Pre-Protocol 80 (22) (n=198)
(n=139)
• Total number of infusions, milligrams received, Post-Protocol 80 (22)
References
1. Remicade (Infliximab)[package insert]. Janssen Biotech, Inc; Horsham (PA):November 2013.
vials used per patient pre- and post-protocol, 2. Tichy EM, Schumock GT, Hoffman JM, Suda KJ, Rim MH, Tadrous M, et. al. National trends
Contributors
and average weight per patient pre- and post- Dawn Feret, RPh, MBA, BCSCP Morgan Wynes, PharmD, MBA, BCPS in prescription drug expenditures and projections for 2020. Am J Health Syst Pharm
protocol. Bryan C. McCarthy Jr., PharmD, MS, MJ,FASHP Andrew Zullo, PharmD, PhD 2020:77(15):1213-1230.