RESUMO
AIM: The evolving chemotherapy landscape continually introduces effective agents, but escalating costs call for an evaluation of drug wastage and financial consequences to enhance resource utilization. This study seeks to estimate chemotherapy drug wastage and its economic loss in paediatric cancer care. METHODS: In this cross-sectional study of paediatric cancer patients receiving parenteral chemotherapy, we evaluated both the drug used and wasted during each administration. The monetary value of drug loss was calculated using the formula: Cost = Proportion of drug wasted X Cost of drug vial. RESULT: A total of 100 paediatric cancer patients who received 140 parenteral drug administrations of 22 chemotherapy drugs were studied. The total amount of drug procured was 25,515 mg, out of which 5,004.9 mg were wasted. Wastage amounted to 19.61% of the procured drugs in varying proportions. The total estimated cost of chemotherapy stood at 110,143.1 INR (1,328.7 USD), with cost wastage accounting for 31,929.95 INR (385.19 USD), equivalent to 28.98% of the total expenditure. Notably, doxorubicin 112.2 mg (37.4%) exhibited the highest drug wastage, followed by cytarabine 280 mg (35%) and l-asparaginase 83,400 IU (26.9%), primarily prescribed for acute lymphocytic leukaemia. Cytarabine resulted in the highest financial loss. Dose rounding occurred in 22 cases (15.71%), while vial sharing was observed in only five cases (3.57%) during drug administrations. Methotrexate, doxorubicin, and cytarabine doses never matched the available vial sizes. CONCLUSIONS: In resource-limited healthcare settings, implementing centre-specific measures, such as vial sharing and drug categorization, can reduce drug wastage and financial losses. Evaluating the viability of optimizing vial sizes and producing multidose vials is essential.
RESUMO
Background and objective New drugs have revolutionized cancer care, but their high cost requires cost-effectiveness studies. However, these studies only consider optimal use, neglecting real-world wastage. We aim to assess chemotherapy drug wastage and financial loss in our adult oncology care. Methods A total of 100 adult patients attending daycare oncology were prospectively evaluated. The total dose of parenteral anticancer drug, the amount administered, and the amount of drug wasted were recorded for each patient. The economic loss estimation was done considering the unit cost for the drug. Results Our study evaluated 157 parenteral drug administrations of 10 different anticancer drugs in 100 enrolled patients. The most common diagnosis was breast cancer (39/100; 39%), and the most commonly prescribed drugs were paclitaxel (36/157; 23%) and cyclophosphamide (21/157; 13%). However, the wastage percentage varied from 6% to 35.06%, and the overall wastage estimated was 16,298 mg (20.06%) of the total drug procured. Notably, the highest proportion of drug wastage was observed for carboplatin (2,525/7200 mg; 35.06%), whereas oxaliplatin, gemcitabine, 5-FU, and cisplatin wastage were more than 20% of the ordered drug. The total cost of the chemotherapy drug procured was 7,26,005 INR (8,738.78 USD), and drug wastage amounted to 17.14% of the total drug cost, resulting in an economic loss of 1,24,485 INR (1,498.40 USD). Gemcitabine (542.86 USD), oxaliplatin (452.66 USD), and paclitaxel (286.15 USD) were responsible for the maximum cost of wastage. Conclusion Drug wastage and financial loss are significant for carboplatin, oxaliplatin, and gemcitabine, with small proportions of paclitaxel also contributing to economic loss. Possible solutions include planning pharmacy inventory for multiple vial sizes and drug-wise batching strategies to facilitate vial sharing. However, these approaches may present challenges. The pharmaceutical industry can consider initiatives such as providing varying packaging sizes to minimize drug wastage.