InsightRx offers advanced dosing metrics that are not available in [competitor applications] which enable real-time feedback to our pharmacists, potentially enhancing overall dosing strategies.
Opportunity
EvergreenHealth, a leading healthcare provider in Washington, was seeking to improve outcomes for patients receiving vancomycin therapy. The network began its vancomycin dosing improvement journey by moving away from trough-based monitoring.
After adopting a trapezoidal AUC calculator, the team transitioned to a competitor’s Bayesian platform to take advantage of more advanced methods. While this initial shift lowered AKI rates, the solution had limitations and did not provide the deeper analytics or predictive insights Evergreen sought. With national guidelines moving away from trough monitoring and a need for a more robust and scalable platform, EvergreenHealth looked for an alternative that could deliver both clinical and economic value.
Solution
By transitioning to Bayesian MIPD, EvergreenHealth clinicians were able to move beyond trough levels as a crude surrogate of exposure. In October 2022, EvergreenHealth implemented the InsightRX Bayesian Model-Informed Precision Dosing (MIPD) platform, following earlier experience with a trapezoidal calculator and then a competitor’s Bayesian solution.
The InsightRX platform offered:
- several 2-compartment (general and population-specific) models for vancomycin
- direct-EHR integration
- in-app efficacy and toxicity assessments to help guide decision support
- real-time analytics dashboards
Impact
Beyond clinical concerns, EvergreenHealth recognized the financial burden of AKI management. Published analyses have shown that Bayesian AUC monitoring can save over $2,000 per patient encounter compared to trough-based strategies, driven by avoided AKI events and lower monitoring costs.1
Figure 1 shows estimated per-patient cost savings for various AUC dosing methodologies, relative to trough-based dosing, for patients receiving vancomycin. (Adopted from Lee et al 2020.)
EvergreenHealth’s transition to InsightRX was driven by both clinical and financial considerations. The organization recognized the burden of AKI management and the need for a more efficient therapeutic drug monitoring process. Published analyses had already shown that Bayesian AUC monitoring could generate significant cost savings compared to trough-based strategies, driven by avoided AKI events and reduced monitoring demands (Lee et al., 2021). These findings further reinforced EvergreenHealth’s decision to move away from trough-based dosing and seek a more robust Bayesian platform.
With InsightRX in place, pharmacists experienced tangible improvements in day-to-day practice:
- Expanded dosing metrics: InsightRX uniquely provided efficacy and toxicity assessments for modeled regimens, giving pharmacists predictive insight into treatment success.
- Streamlined monitoring: Only a single level was needed in stable patients, without requiring steady state, reducing the monitoring burden compared with trapezoidal approaches.
- Guideline-driven care: The shift to AUC-based monitoring aligned EvergreenHealth with national recommendations that emphasize AUC over trough for vancomycin therapy.
Results
Moving to Bayesian model-informed precision dosing decreased AKI rates by 52%
Across more than 1,400 patients reviewed, EvergreenHealth observed a marked reduction in nephrotoxicity rates with Bayesian monitoring. Transitioning from trough-based monitoring to a Bayesian approach was associated with a 52% relative reduction in acute kidney injury (AKI) events. Moving from trapezoidal AUC methods to Bayesian monitoring yielded a 27% reduction in AKI alone. When comparing two different Bayesian platforms, InsightRX demonstrated comparable outcomes to a competitor solution, with the added benefit of advanced dosing metrics that provided pharmacists with actionable insights into both efficacy and safety.
Figure 2 demonstrates AKI event rates by vancomycin dosing methodology. Transitioning to Bayesian MIPD methods markedly reduced AKI rates among patients, compared with either trough-based dosing or trapezoidal-based methods.
Even after accounting for the annual costs of Bayesian programs, there is an incremental financial benefit favoring AUC over trough-based dosing approaches in terms of managing AKI and cost-savings over time.
Conclusions
EvergreenHealth’s transition to InsightRX’s Bayesian MIPD platform demonstrates the clinical and economic value of advanced AUC monitoring. By reducing AKI events, improving guideline adherence, and lowering costs, InsightRX helped EvergreenHealth achieve safer and more efficient vancomycin therapy, establishing a scalable model for other health systems aiming to modernize their precision dosing strategies.