P08 The impact of patient’s compliance and delivery delays: a cost-saving audit on biologics

Background Inflammatory arthritis or ankylosing spondylitis patients who are qualified for biologics treatment will have their medications delivered to their homes by Healthcare at Home (HaH). HaH sends rheumatology department the requests for repeat prescriptions in which the drug delivery due date should be within two weeks of the faxed date on the prescription. Anti-TNF is costly and if the patient already has excess stocks of medications at home then future delivery should be postponed in order to reduce the economic impact on the Trust. This audit aims to investigate the amount of money that could be saved by checking patient’s available medications at home and delay future deliveries. Methods 168 patients were contacted at Croydon University Hospital between 1 - 19 November 2018 by telephone before signing the biologics repeat prescriptions. Patients were asked regarding the number of injections/tablets they have left and whether they had missed any and their reasons for non-adherence. Number of weeks the next prescriptions could be delayed due to the excess amount of injections/medications patients have was calculated and the amount of money saved by delaying the prescription was calculated. Results 133 out of 168 patients answered the phone. Among patients who answered the phone, 59 of them were on etanercept, 6 were on secukinumab, 13 were on etanercept, 24 were on adalimumab, 9 were on methotrexate, 17 were on baricitinib and 5 were on golimumab. Their drug stock at home varied between 0 to 12 weeks. There are various reasons for their excess drug stock in the last 2 months including previous delivery delays or double-delivery (3 patients), infection (20 patients), simply forgotten (7 patients), high liver function tests (1 patient), holiday (6 patients), underwent surgery (1 patient), and underwent a dental procedure (1 patient). By analysing the number of injections/tablets patients have left, we were able to delay repeat prescriptions in 62 patients by 1 to 8 weeks. Theoretically, by delaying sending prescription out to Healthcare at Home for all 62 patients, we would be able to save £13,546.585 for the Trust during the month of November. This made up 6.5% of the monthly cost of anti-TNF inflicted on the Trust in November 2018 (£208,099.94). Conclusion This is a cost-saving audit concerning patient’s adherence to biologics. By verifying the number of excess biologics at patients’ home prior to requesting the repeat prescription, we would be able to reduce the cost inflicted on the Trust greatly. This calls for an improvement in patient education and compliance monitoring. We have launched a biologic patient education programme at Croydon University Hospital which enhances patient’s understanding of biologic treatment. Patients are also encouraged to contact our biologic coordinator if they are non-compliant for any reasons. Disclosures P. Pookarnjanamorakot None. R. Suresh None. P. Webb None.