Implementation of an oncology chemotherapy stewardship process using a novel automated scoring rubric to reduce utilization and costs.

72 Background: The cost of cancer care is an enormous healthcare burden. Most inpatient chemotherapy (IC) is not reimbursed because of diagnosis-related group codes. In March, 2022 we piloted the use of a novel objective scoring rubric to guide and automate IC stewardship at an academic cancer center to decrease the inappropriate use of IC administration, especially among patients at the end of life. Methods: We created a scoring rubric for non-formulary IC that includes type of evidence supporting its use, FDA/NCCN approval, performance status, line, and goal of therapy. If the threshold score for administration is not met, IC is not approved. Standard of care IC that is on formulary is automatically approved. We use descriptive statistics to compare two post-implementation time periods: year 2 (1/2023-6/2023) and year 3 (1/2024-6/2024) on three primary outcomes: utilization, cost and mortality. Descriptive statistics were used for analysis. Results: A total of 405 records were reviewed (Table 1). Approval and disapproval rates remained steady over the years with an average 79% approval rate. Disapproved cases were comprised of Medicare 40% (19), commercial/private 38% (19) and Medicaid 23% (11). Hematologic malignancy (HM) cases were more likely to be approved compared to Solid Tumor (ST) and disapproval rates were higher for ST. Inpatient/30-day mortality for all IC and Immunotherapy alone was greater for disapproved patients by > 10%. Disapproved ST cases were more likely to die within 60 days from the request than HM. There were slightly higher estimated cost savings from the disapproved cases for 2023 compared to 2024. Spending in 2023 was significantly less compared to 2024 despite comparable approval rates (need to confirm) but in the setting of a growing inpatient census year to year. This increased spend is likely explained by increased utilization of immunotherapy such as pembrolizumab, ipilimumab and nivolumab. Conclusions: Physician choice for administration of IC aligned with objective criteria 79% of the time. Alternatively, this tool disapproved IC more often in ST and ST disapproved cases were more likely to die within 60 days. Immunotherapy administration was significantly associated with inpatient mortality and rising costs. Our pilot indicates that there is a role for an objective tool for automated IC stewardship with an emphasis to limit inpatient immunotherapy. Outcome measures. Measure Approval Disapproval Retracted Spending Estimated Cost savings 2023 75%/58 17%/13 8%/6 $882,382 $296,248 2024 83%/82 9%/9 9%/9 $1,691,204 $183,469 LM (169/42%) 92%/156 7%/13 ST (237/58%) 85%/202 15%/35 Inpatient/30Day Mortality Rate for: All NF IC Immunotherapy only 22%/79 23%/58 40%/1937%/13