As health care costs continue to rise, cost containment is on everyone’s mind. Cutting services and benefits might save money, but it’s not a very satisfying way to serve patients.
Easily implementable health care practices and policies that reduce costs while preserving high-level care make much more sense. Self-administration of injectable medications fits the bill here and would “reduce costs and improve patients’ well-being, socioeconomic situations, and compliance and treatment without compromising patient safety,” points out Jeff Farroni, Ph.D., a Clinical Ethicist at M.D. Anderson Cancer Center in Houston in a recent issue of the New England Journal of Medicine.
The example of the medication azacitidine, which is used to treat myelodysplastic syndrome, highlights Dr. Farroni’s case. This medication injected in an office setting bills at about $400 per injection. Considering that a patient generally requires six cycles of injections each year; the total cost quickly rises up to $12,600-21,000 per patient. Medicare costs would drop substantially if these patients could self-administer, even taking into account the costs of proper training and on-going monitoring from health care professionals that would still be needed by each patient.I couldn’t agree more with Dr. Farroni’s cost-cutting recommendation. In fact, BioPlus, as a specialty pharmacy, already provides this service, as do home health networks. There are several independent bodies that accredit this type of practice. Medicare’s current policy, however, does not generally cover self-administered medications. In order to be reimbursed, doctors covering Medicare patients have to administer injections in their offices, “even if physicians believe that self-injection will both reduce costs and increase treatment effectiveness,” laments Dr. Farroni.
It’s not just about saving money; self-injections can also improve health outcomes. For instance, azacitidine should be used on a seven-day treatment regimen. Yet only 20 percent of patients follow this seven-day plan due to logistical barriers such as physician offices being closed on weekends. With certain injectable medications, such as antibiotics, some patients are hospitalized so that the course of treatment can be completed. With a switch to self-administration in these cases, the cost of hospitalization would disappear, while freeing up hospital beds for other patients.
Although most intravenous injectables, for otherwise ambulatory patients, tend to be given in the ER or at out-patient clinics (and not during a hospital admission) the cost is still higher than at home administration. The cost savings is significant, even if a registered nurse comes to administer the injection or if the patient or a caregiver is educated in self-administration.
Self-administration of injectable medications can improve care and save money, but would require numerous safeguards, as Dr. Farroni accurately notes, which include:
- Initial supervision of self-administration
- Patient follow-up by phone or e-mail by health care professionals
- Monitoring of blood or other appropriate criteria
- Checks of blood levels of the medication or organ function
What do you think
Stephen C Vogt, PharmD
President and CEO BioPlus SP