Impact of Bone Marrow Transplant (BMT) Pharmacist (pharma) Interventions on Outcomes in Patients (pts) Undergoing Transplantation at an Academic Medical Center

BACKGROUND:

Multidisciplinary collaboration leads to improvement in pt outcomes when clinical pharmas are engaged in various settings.  Clinical pharma integration in the BMT setting has increased as these programs expand.  There is an absence of literature defining the benefit of clinical pharma involvement in this area of practice.  UMass Memorial Medical Center is a large academic medical center performing 108 allogenic transplants since 2010.  In August 2010, the medical center implemented the integration of a health-system clinical pharma to the BMT team. This study aims to determine the impact of a health- system based clinical pharma on pt outcomes and associated costs in the BMT setting.

METHODS

Records for pts receiving an allogeneic stem cell transplant (ASCT) from January 2008 to August 2012 were reviewed. The primary outcome measure was difference in length of stay (LOS) for ASCT prior to and after pharma integration on the BMT team. Secondary outcome measures include number of readmissions within 30 days, overall survival at 100 days, duration of intravenous (IV) antimicrobial therapy, duration of IV immunosuppressive therapy (IST), and duration of oral IST.

RESULTS:

106 pts were identified and included for analysis. 45 were transplanted prior to pharmacist implementation and 61 were after BMT.  Baseline demographics were similar between the two groups.  In the pre and post group, the most common indication for transplant was AML (40% vs. 51%) and the most common source was a matched unrelated donor (60% vs. 62%).  The majority of pts in both groups received myeloablative regimens (80% vs. 69%). LOS was decreased in the after group but was not statistically significant (24.8 vs. 22.9 days, p = 0.43).  100-day survival (80% vs. 88.5%, p =0.23) and readmission within thirty days were not significantly changed (42.2% vs. 37.7%, p=0.64).  Days of IV antibacterials, antivirals and antifungals were all decreased, but were not statistically significant. Days on IV IST were significantly decreased (21.4 vs. 11.3 days, p=0.001) showing a reciprocal increase in oral IST use (4.9 vs. 9.1 days, p=0.001).  Costs benefits were assessed using 2013 WAC prices.  Cost savings were reported as $3,083 per pt, for a total benefit since implementation of $184,985 or $92,493 per year.

CONCLUSION:

Our analysis demonstrates significant improvements in cost saving with the implementation of a pharma in the BMT setting, specifically allogeneic pts.  While not statistically significant, our results did show a trend in decreased LOS, readmission at 30 days, and use of antimicrobials. Use of IV IST were significantly decreased.  Incorporation of clinical pharma should be strongly considered in this pt population.