Background Annual IV zoledronate has been shown to be the most effective bisphosphonate in fracture prevention. It is therefore first-choice now when starting new IV therapy in our department when osteoporosis patients are unable to take oral bisphosphonates. However, we have several patients on quarterly IV ibandronate and pamidronate started previously. While it was considered clinically effective to switch them to zoledronate, there was a concern regarding potentially increased departmental pharmacy costs.
Objectives Our objective was to find out if reviewing patients on IV ibandronate and pamidronate using a structured quality improvement process with involvement of a pharmacist with a view to switching them to zoledronate would be clinically appropriate and would also be cost-effective.
Methods Patients on IV pamidronate and ibandronate were identified on the department’s database (7 excluded: died before next due infusion; 2 excluded: off IV bisphosphonate due to ongoing dental treatment). Their case notes were reviewed by a senior rheumatology pharmacist and a consultant rheumatologist to confirm and agree appropriateness of indication and suitability for continuing IV bisphosphonate. Up to date renal and bone profile, and DXA scan were obtained and reviewed. Once an appropriate clinical decision was made, patients were contacted on the phone or reviewed in the metabolic bone clinic to discuss and obtain verbal consent for the proposed future management including switching to IV zoledronate. IV bisphosphonate costs were obtained from our Central Pharmacy (per yr: pamidronate 30mg £176 & 60mg £268; IV ibandronate £312; zoledronate £187). Oral bisphosphonate costs were obtained from Cost Comparison Charts (Oct 2012) from Wolfson unit, Newcastle-upon-Tyne (per yr: weekly alendronate £10.27p; monthly ibandronate £239). Cost savings were calculated as the difference between actual cost based on the clinical decison and the potential cost if previous treatment continued unchanged.
Results 37 patients on pamidronate (28 on 30mg & 9 on 60mg infusions) and 38 patients on IV ibandronate were included in the analysis. In pamidronate 30mg group 17 were switched to zoledronate, 2 were switched to weekly alendronate and 6 went on bisphosphonate holiday. In pamidronate 60mg group, 6 were switched to zoledronate. In IV ibandronate group, 22 were switched to zoledronate, 1 to monthly oral ibandronate and 5 went on bisphosphonate holiday. Annual savings achieved so far were £1686 for pamidronate group and £4402 for ibandronate group (total £6088). If the remaining 6 patients on pamidronate and 10 patients on IV ibandronate awaiting results review also switch to zoledronate, there would be additional savings.
Conclusions We found that reviewing osteoporosis patients on IV ibandronate and pamidronate using a structured quality improvement process involving a rheumatology pharmacist resulted in taking appropriate clinical decisions including switching to IV zoledronate. This has produced significant recurrent annual drug cost-savings in addition to the known clinical benefits. In other settings, there are also likely to be other identifiable savings, eg. administration costs which at present are not included in our departmental costs.
Disclosure of Interest None Declared