Reducing Hospitalizations: Institution of Outpatient Infusional EPOCH-based Chemotherapy at a Safety-Net Hospital

From the 2018 HVPAA National Conference

NEIL KESHVANI (University of Texas Southwestern Medical Center, Dallas, TX;), Arjun Gupta (University of Texas Southwestern Medical Center, Dallas, TX;), Corbin Eule (University of Texas Southwestern Medical Center, Dallas, TX;), Eileen Marley (University of Texas Southwestern Medical Center, Dallas, TX;), Hsiao C. Li (University of Texas Southwestern Medical Center, Dallas, TX;), Navid Sadeghi (University of Texas Southwestern Medical Center, Dallas, TX;)

Background

EPOCH-based chemotherapy regimens have traditionally been administered inpatient because they include a continuous 96-hour infusion. These routine admissions are costly, disrupting, and isolating to patients.

Objectives

Transition EPOCH-based chemotherapy regimens to an ambulatory infusion model at our safety-net hospital and quantify the effects of avoided hospitalization and outpatient administration of medications on overall healthcare costs.

Methods

Guidelines for chemotherapy administration and educational materials were developed through a multidisciplinary collaboration with hematology/oncology, nursing, and pharmacy. Data were collected through chart review and the finance department.

Results

From 1/30/2017 through 1/30/2018, 87 cycles of EPOCH-based chemotherapy were given to 23 individual patients. Sixty-one cycles (70%) were administered in the outpatient setting to 18 individual patients. There was a 57.6% reduction in drug cost per cycle due to the lower cost of drug acquisition in the outpatient setting. Of the 26 cycles that were administered in the hospital, 18 (69%) were the first cycle of treatment. In one patient due to poor performance status and lack of transportation, all 6 cycles were administered inpatient, accounting for 23% of inpatient treatments. Per previous published data, an additional $3,291 per cycle was saved from each prevented 5-day admission, totaling $200,751. An estimated 336 days of hospital stay were avoided. Rates of inappropriate prophylactic antimicrobial prescription and laboratory draws were markedly lower in the outpatient setting.

Conclusion

Multiday EPOCH-based regimens were successfully and safely administered in an ambulatory setting in our safety net urban hospital system.

Implications for the Patient

Outpatient therapy allows patients to receive treatment in their own environment and leads to significant savings through avoided hospitalizations and reductions in drug acquisition cost.