Effects of a Utilization Management Program for IVIG

1
Effects of a Utilization Management Program for
IVIG

• Ms Shannon Selin, Dr. David Pi
• British Columbia Provincial Blood Coordinating
  Office
• Vancouver, BC, Canada

2
Objectives

• 1) To reduce inappropriate use of IVIG.
• There were annual double-digit percentage
  increases in Canadian IVIG consumption from 1991
  to 2001.
• Canadian IVIG consumption per capita is among the
  highest in the world.
• A 1999 study of IVIG use in British Columbia (BC)
  found 21 of use was inappropriate.
• 2) To increase physician accountability for IVIG
  use.
• 3) To make it easier to monitor IVIG use.
• 4) To provide feedback to clinicians on IVIG use.

3
Method1) Guidelines

• The programs guidelines were developed by a
  provincial task force of transfusion
  professionals, clinical specialists and policy
  makers based on current medical literature.
• The guidelines consist of a list of approved
  medical conditions for IVIG use.
• These are conditions for which there is
  convincing evidence of benefit or high level of
  evidence of benefit of IVIG therapy.
• The BC Health Ministry will routinely fund IVIG
  use for the listed conditions if specified
  prerequisites have been met.

4

• General prerequisites include
• A definitive diagnosis must be confirmed.
• For immune deficiency conditions, serum IgG
  levels must be clinically assessed.
• For other conditions, equally efficacious less
  expensive alternative therapy must have been
  tried and failed.
• There must be regular clinical outcome
  assessment.
• There are also specific prerequisites for each
  condition.
• The program includes recommendations regarding
  treatment, review and outcome
• size and frequency of dosage
• what to monitor, how frequently and under what
  circumstances IVIG use should be
  continued/discontinued.

5
Method2) Education

• The BC Health Ministry established a centralized
  IVIG Centre to provide medical and technical
  support to hospitals.
• Resource material was distributed
• IVIG Utilization Management Handbook
• Quick reference cards
• Program implementation guide and SOP with
  flowchart
• Patient pamphlet
• There were inservices for physicians,
  technologists and nurses.
• There were specialty-specific peer discussions.

6
Method3) Gatekeeping

• There is hospital transfusion service screening
  of all IVIG requests to ensure they meet program
  guidelines.
• Use for conditions not on the approved list
  requires special approval from the IVIG Centre
  (the requesting physician telephones the Centres
  medical consultant).
• For special requests, there is individual
  specialist consultations with physicians about
  patient care.
• Requests for IVIG for research purposes are
  evaluated on a case-by-case basis.

7
Method4) Monitoring

• Hospitals report IVIG use to the IVIG Centre
• Patient demographics and medical condition
• Dosage
• Canadian Blood Services (CBS) provides the IVIG
  Centre with supply-side data.
• The IVIG Centre monitors the breakdown and trend
  in use.
• The IVIG Centre monitors special approvals, with
  reminders back to physicians regarding the need
  to review outcome to justify continuation of
  therapy.

8
Implementation

• The program was implemented in a pilot phase at
  six large hospitals beginning in February 2002.
• The program was extended to all British Columbia
  hospitals (over 90 sites) in summer/fall 2002.
• The program continues to operate.

9
Results

• Growth in IVIG use has been curbed (see chart).
• There has been positive feedback from transfusion
  services and specialist clinicians.
• Value of program champions within regions and
  within clinical specialties
• Value of education about the cost of IVIG
• 13 of use has been for special approvals.
• scattered among 35 different conditions
• Future efforts will involve focusing on key
  physician/patient groups (e.g., neurology).

10
Stabilization of Growth in IVIG Utilization
6.78

• Source Canadian Blood Services

11
Breakdown of IVIG use (volume) by Condition,
April 1, 2002 March 31, 2003
12
Breakdown of IVIG use (volume) by Specialty,
April 1, 2002 March 31, 2003
13
Conclusion

• The program has met its objectives.
• A cooperative partnership among the medical
  community, the blood supplier and government has
  been key to the programs success.
• The program has aimed to combine quality of care
  and cost containment.
• For approved conditions, further follow-up is
  required to assess the appropriateness of dose,
  dosing intervals and duration of therapy.
• There is need for ongoing physician education,
  monitoring and review of new indications for IVIG
  therapy.

14
Contact

• Shannon Selin
• Provincial Blood Coordinating Office
• Hornby Site, St. Pauls Hospital
• 1081 Burrard Street
• Vancouver, BC, Canada V6Z 1Y6
• Phone [phone], Fax [phone]
• sselin_at_providencehealth.bc.ca
• www.bloodlink.bc.ca