Efficiency Outcomes Associated with Increased Ferumoxytol Use In An Infusion Clinic

Abstract 5151

Patients with iron deficiency anemia (IDA) may require intravenous (IV) iron supplementation in an outpatient hematology setting. Such infusions require multiple visits and several hours of patient time. Ferumoxytol (Feraheme®) Injection is a novel IV iron approved for IDA in patients with reduced kidney function (CKD stages 1–5). Ferumoxytol requires fewer visits and fewer hours per treatment than other IV iron treatments. For instance, iron sucrose is generally given to nondialysis CKD patients in 200 mg doses given in five separate 1 hour infusions while ferumoxytol may be given in 510 mg doses given as a rapid injection in 2 visits.

The objective of this analysis was to understand the impact of increased ferumoxytol utilization on patient, staff and financial efficiency metrics for an outpatient infusion clinic. Data on IV iron and other procedure mix, payer mix, length of clinic visit, medication and administration costs, and treatment revenue were collected from hospital financial data, staff interviews and pharmacy records for the 10-chair outpatient infusion clinic of a 325-bed academically-affiliated, non-profit hospital from January 1, 2008 through June 30, 2010. Cost of medication and administration used in each procedure came from the hospital's cost accounting system, revenue was captured as the amounts reimbursed by payers and margin was calculated as the difference between costs and revenue. Cost, revenue, margin and chair time required per IV iron treatment were analyzed for each year and estimated for 2011 utilization. Per hour efficiency metrics were calculated as the total revenue divided by total hours for each procedure. Revenue and margin per hour for the clinic's other administered therapies were also analyzed and modeled to quantify the projected financial impact of allocating freed IV iron chair time to these therapies.

The clinic estimates that 80% of patients receiving IV iron treatment have reduced kidney function. Ferumoxytol treatment became available in 2009 and its share of the clinic's administered IV iron increased from 0% in 2008, to 25% in 2009, and to 42% in 2010. From 2008 to 2010, the clinic's use of iron sucrose dropped from 12% to 4%, sodium ferric gluconate decreased from 65% to 5% and iron dextran increased from 23% to 49%. The clinic forecasts that ferumoxytol will represent 60% (in 75% of ferumoxytol-eligible patients) of all IV iron administered in 2011. Because ferumoxytol requires 30 minutes per visit vs. 1.5 to 4.5 hours for other IV iron treatments, the average number of patient hours required to infuse a gram of IV iron in the clinic dropped 80% from 9.6 hours in 2008 to 1.9 hours in 2010. Furthermore, our study estimates that the clinic saved 282 hours of chair time in 2009 and the first half of 2010, and will save an additional 23 hours in 2011 by further increasing ferumoxytol utilization. Staff interviews suggested that ferumoxytol IV iron procedures were associated with improved clinic efficiencies such as reduced pharmacy preparation time (10-15 minutes less time) and improved availability of high demand equipment such as IV smart pumps. While total IV iron medication cost increased from 2008 to 2010, decreased chair time resulted in increased revenue per hour for IV iron medication (542%) and IV iron administration (153%). IV iron medication and administration margins per hour also increased (370% and 571%, respectively), moving the clinic's overall IV iron treatment margin per hour in line with their higher margin therapeutics, such as chemotherapy agents, erythropoietin, and monoclonal antibodies. By 2011, the clinic will have increased IV iron medication and administration revenue per hour by 858% and 195%, respectively over 2008 figures, and margins per hour by 588% and 753%, respectively, over 2008 figures. Given the clinic's average revenue and margin per hour for the current mix of other (non-IV iron) infusion therapies, reallocation of freed chair hours to other infusion therapies represents an additional clinic revenue and margin opportunity of $191,669 and $18,670, respectively.

In conclusion, increasing use of ferumoxytol in an outpatient infusion clinic was associated with patient, staff and clinic efficiencies including fewer IV iron patient visits, decreased IV iron procedure time, the opportunity for increased clinic throughput and a substantial increase in overall IV iron revenue and margin per hour.