Reducing Drug Waste Through Dose Rounding of Bevacizumab With Puneeth Indurlal, MD

In this interview from the American Society of Clinical Oncology (ASCO) 2023 Annual Meeting, Dr. Puneeth Indurlal, Senior Director for Care Transformation at the US Oncology Network, discusses his team’s abstract regarding dose rounding of bevacizumab, the potential for minimizing drug waste, and reducing the cost of care.  

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we’re here at the ASCO Annual Meeting, and I’m joined by Dr. Puneeth Indurlal. Thanks so much for coming on today.

Puneeth Indurlal, MD: Thank you for having me.

Oncology Data Advisor: Would you like to introduce yourself and share what your work and your research focus on?

Dr. Indurlal: My name is Dr. Puneeth Indurlal. I’m a Senior Director for Care Transformation at the US Oncology Network. We’ve been focusing a lot on value-based care and how we can help bend the cost of care within oncology. A lot of our research is focused on that.

Oncology Data Advisor: Great. So, you have a study here on dose rounding bevacizumab and its biosimilars to reduce drug waste. For background, why is reducing drug waste important in oncology?

Dr. Indurlal: Drug waste is an unnecessary and wasteful expenditure in the total cost of care, and it’s a no-brainer to try and focus on it because it’s an avoidable expenditure in the total cost of care. It impacts patients, it impacts the health care system at large, and it also impacts providers who are providing care. That gives us enough reason to focus on and reduce drug waste within the health care space.

Oncology Data Advisor: Definitely. So, what is dose rounding, and how does this help to mitigate drug waste?

Dr. Indurlal: Dose rounding uses the principle that you could tailor up or down the dose of medications, mostly down, to a lower dose so as to avoid waste from any partially used single dose vials. For example, if you have a dose of 710 mg, and you’re using an 800-mg vial of the drug and discarding 90 mg, you could round the dose down to about 700 mg and save an entire vial, or 100 mg, of the medication from being discarded.

Oncology Data Advisor: Wow, that’s very interesting. Why did you decide to target bevacizumab for this study?

Dr. Indurlal: We actually focused on multiple drugs, but we picked bevacizumab because it didn’t undergo as many changes as some of the other medications did in terms of the evaluation. Bevacizumab has had the same vial size since the time we implemented the dose rounding initiative.

Oncology Data Advisor: What were the findings of the dose rounding study?

Dr. Indurlal: Prior to initiating the study and the dose-rounding approach, we had about 5.3% waste on all of the administrations of bevacizumab. Subsequently, we implemented the initiative at multiple practices within the US Oncology Network. We have seen a dramatic reduction, almost 55% reduction. As of 2021, the drug waste with bevacizumab was about 2.5%. So, we saw almost more than a half reduction of drug waste in bevacizumab and its biosimilars.

Oncology Data Advisor: That’s very impressive. What other drugs could benefit from dose-rounding approaches?

Dr. Indurlal: Many of the biological agents and even cytotoxic agents could benefit from them. We have implemented dose-rounding initiatives on not only bevacizumab, but also rituximab, trastuzumab, carfilzomib, daratumumab, and many other agents. On the cytotoxic side, dose rounding could also be implemented on pemetrexed and protein-bound paclitaxel. So, there are several other medications that it could be implemented on.

Oncology Data Advisor: Since the theme of ASCO this year is “Partnering with Patients,” how do these approaches towards dose rounding and reducing drug waste fit into this theme?

By implementing these dose-rounding strategies, we have been able to bend the cost curve and save money for the health care system at large, but also to reduce the patient burden of co-payments on those wasted medications.

Dr. Indurlal: There are two aspects to focus on when it comes to patients. One is whether there is any compromise to the efficacy of the treatment. We used the guidelines that were put out by the Hematology/Oncology Pharmacist Association and endorsed by the National Comprehensive Cancer Network (NCCN), so we were confident that these approaches would not compromise the quality of patient care or the efficacy of these medications. The second space is where patients are also sharing in the cost burden of these medications. By implementing these dose-rounding strategies, we have been able to bend the cost curve and save money for the health care system at large, but also to reduce the patient burden of co-payments on those wasted medications.

Oncology Data Advisor: Great. Anything else you’d like to mention or share about this?

Dr. Indurlal: I think dosing strategies for a lot of the expensive biological agents and cytotoxic agents in oncology could be looked at as a potential target to bend the cost curve and also avoid wasteful spending.

Oncology Data Advisor: Thanks so much for stopping by to talk about the study. It was really interesting to hear about.

Dr. Indurlal: Thank you for having me.

About Dr. Indurlal

Puneeth Indurlal, MD, is the Senior Director for Care Transformation at the US Oncology Network. His research focuses on value-based care and ways to reduce the cost of care within oncology, including through dose rounding of medications.

For More Information

Indurlal P, Alam N, Garey JS & Willfong LS (2023). Dose rounding bevacizumab and its biosimilars to reduce drug waste in the oncology care model in a community oncology network. J Clin Oncol (ASCO Annual Meeting Abstracts), 41(suppl_16). Abstract 1529. DOI:10.1200/JCO.2023/41.16_suppl.1529

Transcript edited for clarity. Any views expressed above are the speaker’s own and do not necessarily reflect those of Oncology Data Advisor. 


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