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Potential cost savings with implementation of systemwide Rasburicase protocol
Purpose: Tumor Lysis Syndrome is a condition that takes place when apoptosis in cancer cells occurs within a short time period. This condition can lead to organ dysfunction and even death. Rasburicase is used to treat high uric acid levels in patients that are experiencing tumor lysis syndrome and is expensive. Dosing and frequency of rasburicase varies across health care institutions. This project evaluated if adherence to a systemwide rasburicase protocol could help reduce drug waste and reduce costs across a healthcare system.
Methods: We conducted a retrospective data analysis reviewing rasburicase doses administered across Intermountain Healthcare over the course of one year. A report was generated that collected all rasburicase doses administered between July 1, 2020 to June 30, 2021 and related uric acid lab draw times and respective results. Analysis of this data report included rasburicase dose administered, rasburicase dose recommended per protocol based upon uric acid level, and if uric acid lab draws were drawn at appropriate intervals. No patient identifiers were collected. The protocol that was utilized to evaluate the data set recommended 3mg of rasburicase for patients experiencing hyperuricemia, which was defined as uric acid above 8mg/dL, or 6mg of rasburicase as an initial dose if baseline uric acid was > 14mg/dL. The recommended time for lab draw was 6 hours after rasburicase administration, followed by repeat doses if uric acid levels were higher than 8mg/dL. The rasburicase dose difference in milligrams was reported out, and the average wholesale price was applied to determine cost difference. Additionally, the number of inappropriate lab draws was totaled. Data was stored on a de-identified document in a password protected file. This project was process improvement in nature therefore the institutional review board approval was not deemed necessary.
Results: A total of ninety-nine rasburicase doses were evaluated. Seventy-five doses (75.6% of doses) were administered off protocol, resulting in 210 mg of additional rasburicase dispensed. This equated to an additional $160,947 of extra hospital drug-related costs. A total of ninety-nine uric acid lab results were reviewed after the initial rasburicase dose. Of those, thirty-five (35%) were drawn inappropriately, or too soon.
Conclusions: The results determined that in one year, the healthcare system could have saved an average of $160,947. Additionally, uric acid lab monitoring could be standardized. Future direction includes physician education and implementation of a system-wide rasburicase protocol and evaluation of cost savings related to rasburicase dosing and lab monitoring.