Researchers found that dose-adjusted (DA-) etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (EPOCH) for B-cell lymphomas can be administered safely in the outpatient setting and that outpatient administration was associated with significant savings relative to inpatient administration.

Wenhui Li, PharmD, of the H. Lee Moffitt Cancer Center in Tampa, Florida, and colleagues published their findings in an abstract associated with the  National Comprehensive Cancer Network (NCCN) 2020 Annual Conference, which was postponed in response to the coronavirus disease 2019 (COVID-19) pandemic.

According to the authors, many health care centers would like to transition to outpatient administration of DA-EPOCH to decrease costs and improve the patients’ experience. Therefore, the team aimed to assess the safety and cost savings associated with DA-EPOCH using an inpatient/outpatient (IPOP) program they developed at the Moffitt Cancer Center (MCC). They hypothesized that outpatient administration of DA-EPOCH in a tertiary comprehensive cancer center is both safe and cost effective. 

The investigators conducted a retrospective chart review of adult patients who were treated with DA-EPOCH for B-cell lymphomas (double- or triple-hit diffuse large B-cell lymphoma, high-grade B-cell lymphomas, primary mediastinal large B-cell lymphoma, and Burkitt lymphoma) at the MCC from April 26, 2017, to August 10, 2019.


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Both safety data (hospitalizations, infections, and incidence of neutropenic fever, extravasations, drug spills, pump-malfunctions, and drug-related adverse events) and data from the institution’s financial department were evaluated. 

Of DA-EPOCH administered during the study period, 88% (193/219) of cycles were administered to 56 patients in the outpatient setting. No hospitalizations occurred during the outpatient administration of the treatment. The team estimated that the outpatient administration of DA-EPOCH translated into 965 hospital days that were saved. In between cycles, 41% of patients (23/56) were hospitalized. Of 40 total hospital admissions, most (52%) were due to neutropenic fever.

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During outpatient DA-EPOCH administration, no extravasations occurred, and few drug spills (3 incidences) and pump malfunctions (4 incidences) occurred. Approximately 32% of patients (18/56) experienced neuropathy and needed their vincristine dose adjusted.

The relative savings generated by the outpatient DA-EPOCH administration was approximately $905,589 USD (reported as the annual revenue increase) compared with inpatient administration.

“Specific details regarding administration of DA-EPOCH in IPOP and supportive medications will be reported,” the authors concluded.

Reference

Li W, Simondsen K, Tobon K, McCarthy K, and Kubal T. BPI20-015: Safety and financial analysis of outpatient dose-adjusted EPOCH for B-cell lymphoma at a tertiary comprehensive cancer centerJ Natl Compr Canc Netw. 2020;18(3.5):BPI20-015-BPI20-015.