Safety and financial analysis of outpatient HyperCVAD arm A administration for acute lymphoblastic leukemia

Introduction Our institution transitioned the administration of hyperCVAD arm A to the outpatient setting via an Inpatient/Outpatient (IPOP) program. This study aims to evaluate the safety and financial impact of administering hyperCVAD arm A in the outpatient setting. Design Retrospective chart review was conducted on adult patients who received hyperCVAD arm A for treatment of ALL at our institution between January 2019 and July 2020. The primary endpoint of the study is incidence of hospital admissions during outpatient administration of hyperCVAD during arms 2A, 3A, and 4A. Secondary endpoints include hospitalizations between cycles, hospital days saved, infectious complications, adherence to infection prophylaxis guidelines, and drug-related adverse events. Financial analysis was conducted based on reimbursement data and impact of hospital bed backfill to determine the overall financial impact. Results A total of 103 cycles of hyperCVAD arm A were administered, with 56 cycles given outpatient to 26 patients. One (4%) patient required hospitalization during outpatient chemotherapy administration, while 8 (31%) patients were hospitalized after completing day 4 of each cycle for reasons not directly related to treatment. Grade >3 hematologic adverse events were prevalent, but no patients were removed from the program due to adverse effects. The utilization of the outpatient program resulted in an estimated 280 avoided hospitalization days during the study period and 60% increase in margin based on reimbursement. Conclusion Outpatient administration of hyperCVAD arm A was safe and feasible, with minimal hospitalizations occurring during treatment cycles. The outpatient approach demonstrated favorable financial implications and alleviated bed shortages.