Background Belatacept (Nulojix), combined with mycophenolic acid and steroids, is licensed for immunosuppression after kidney transplantation. Unlike oral immunosuppressants (e.g. tacrolimus) belatacept infusions are not reimbursed by Austrian health insurance schemes. Hospitals have to cover the entire costs of monthly infusions.
Purpose To evaluate the economic benefits of centralised aseptic belatacept compounding in the hospital pharmacy (HP) and the feasibility of pooling patients on specific infusion days in the nephrology day clinic of the largest Austrian kidney transplant centre as potential cost-containment strategies.
Materials and methods Belatacept infusions were compounded by the HP on defined days. Patients were scheduled for infusion by the ward team as comprehensively as possible. Additional single vials were only dispensed for newly transplanted patients who had not yet been synchronised or if appointments had been missed. Compounding protocols, usage data of single vials, and patient schedules were analysed over 20 months. Theoretical and real numbers of vials were compared. The ex-factory price was used to calculate savings. Only belatacept costs were considered.
Results 22 patients received a total of 319 belatacept infusions with a mean (±SD) maintenance dose of 397 (±76) mg. 267 (83.7%) infusions were compounded by the HP and administered on 60 infusion days (median 4 infusions/day). 151 single vials for 52 additional infusions were dispensed, of which 28 vials (18.5%) were used to compensate for missed infusion appointments. Patient synchronisation and centralised compounding yielded savings of about 41,000 €, corresponding to annual belatacept costs of 2.5 patients (70 kg). Savings directly correlated with a higher number of scheduled patients per day (Spearman ρ = 0.817).
Conclusions Centralised aseptic compounding led to significant savings of belatacept costs. Organisational efforts to pool patients on specific infusion days are high and have to be balanced against the potential for further savings.
No conflict of interest.
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