Improving Value by Standardizing the Use of IVIG Amongst Pediatric Solid Organ Transplant (SOT) Patients.
1Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati
2Division of Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati
3Solid Organ Transplant Center, Cincinnati Children's Hospital Medical Center, Cincinnati
Meeting: 2017 American Transplant Congress
Abstract number: A270
Keywords: Immunoglobulins (Ig), Safety
Session Information
Session Name: Poster Session A: Transplant Economics and Pharmacy Value Initiatives
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Background: Given the high cost of pharmaceuticals (i.e. IVIG), we sought to determine if unnecessary variation in drug use may be an opportunity to improve value in SOT patients.
Methods: We used the Pediatric Health Information System to learn that the use of IVIG at our center was 5-fold greater than similar institutions. IVIG use from 9/14 to 8/15 (pre) and from 8/15-2/16 (post) was reviewed including waste, drug indications, drug-related adverse events (AEs) and use of hospital beds. Using QI methodology, interventions were designed to standardize practice. The modified Delphi technique gained provider consensus for use for a subset of patients. Cost analysis was compared pre and post.
Results: Pre intervention, 15,283 g/yr (est. $2.3 mil) of IVIG was dispensed. Of the total, 6% was waste due to non-standardized dosing (obesity), use of inappropriate vial size and medication dispensed but not administered. Post interventions (additional vial sizes, dose standardization, optimal obesity dosing and adding high dose flag to EMR) 2% of the dispensed product was wasted (est. savings of $215k/yr). For the subset that indications and dosing were protocolized, retrospective application of new guidelines revealed a decrease in use from 6541g to 3731g; cost savings est. at $422k/yr. Since implementation, there have been no AEs compared to 12 AEs that occurred pre. Hospital flow improved. Interventions that were designed for SOT spread hospital wide and resulted in a 34% reduction in overall IVIG use.
Conclusion: Interventions to decrease inappropriate IVIG use were successful across SOT and led to substantial cost savings, standardization of practice, improved hospital flow and value. Components of this project were spread hospital wide and could be applied to other high cost pharmaceuticals to improve value.
CITATION INFORMATION: Sawyer J, Bucuvalas J, Danziger-Isakov L, Gossett J, Burkhart L, Lorts A. Improving Value by Standardizing the Use of IVIG Amongst Pediatric Solid Organ Transplant (SOT) Patients. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Sawyer J, Bucuvalas J, Danziger-Isakov L, Gossett J, Burkhart L, Lorts A. Improving Value by Standardizing the Use of IVIG Amongst Pediatric Solid Organ Transplant (SOT) Patients. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/improving-value-by-standardizing-the-use-of-ivig-amongst-pediatric-solid-organ-transplant-sot-patients/. Accessed May 12, 2025.« Back to 2017 American Transplant Congress