Utilization Management, Purpose Built for Oncology

Oncology Analytics received a request for Rituxan for the treatment of lymphoma in a 62-year-old patient who presented with weakness and fatigue. After reviewing the medical records, it appeared that the available information did not clearly support the requested treatment. An Oncology Analytics medical director consulted with Dr. John Lister, a Pathologist at Johns Hopkins Hospital and a member of Oncology Analytics Distinguished Academic Advisory Board. Dr. Lister, who specializes in hematologic malignancies, concurred that a diagnosis of lymphoma was not established and that treatment was not indicated. Dr. Lister called the treating physician and after a thorough review of the case, it was agreed that treatment was not needed.

Outcome: Rituxan is used to treat a variety of lymphomas. However, this patient did not have evidence of lymphoma. Rituxan has been associated with fatal infusion reactions, kidney failure, bowel obstruction, infections, and other severe side effects. Administering Rituxan would have subjected the patient to the risk of complications without any associated benefit.

Savings: Approximately $6,200 per treatment or approximately $74,000 over 2 years.