Development of the ESA Assessment for Safety Improvement (EASI) Online Decision Support Tool

This project supported initial validation of the ESA Assessment for Safety Improvement (EASI) online support tool. The purpose of this tool is to help clinicians navigate the complicated diagnostic and treatment guidelines developed by the National Cancer Care Network (NCCN) and the National Kidney Foundation (NKF) when prescribing erythropoietic-stimulating agents (ESAs). These guidelines emphasize patient safety and drive reimbursement from insurance. Problem Statement Initial clinical studies showed that aggressive use of erythropoietic-stimulating agents (ESAs) increased the risk for thrombosis and decreased overall survival in patients with cancer. As information evolved about the safe, more careful and conservative use of ESAs, safety guidelines were produced and frequently updated. These changes have led to providers underutilizing this treatment in fear of doing harm to patients and not being reimbursed for the treatment by insurers. At more than $1,500 to $3,000 for each injection, losses from lack of reimbursement have been significant to patients and providers. Objectives:  Determine whether an ESA decision analysis tool could have prevented treatment outside of clinical guideline recommendations.  Determine whether an ESA decision analysis tool could have identified treatment outside of financial reimbursement requirements.  Complete first draft of manuscript for submission to peer review journal Literature review Safety concerns are associated with all treatments for anemia. Current evidence indicates that ESAs are an appropriate and safe alternative to pRBC transfusions when used within NCCN and NKF guidelines. Clinical decision tools have also demonstrated improved patient safety, as well as, improved efficiency of clinician time and resources. Implementation and evaluation An historical cohort of 105 patients who received an ESA while undergoing chemotherapy was identified through the Huntsman Cancer Hospital (HCH) pharmacy. Diagnosis, characteristics and lab values for dates of treatment were entered into the EASI tool then compared to actual treatments rendered. The tool identified that overall 22% of treatments rendered were inconsistent with clinical practice guidelines. Based on today's cost of Aranesp® this translates to about $197,000 in savings from 2008 to 2013.