Anticancer drug waste minimization and cost-saving study by using a closed-system transfer device for chemotherapy compounding.

INTRODUCTION: There is a need for an economic evaluation of the use of closed system (CSTD) in chemotherapy compounding, especially in resource-constrained settings. OBJECTIVE: The objective of this study was to assess the cost saving of the management of cancer drug leftovers before and after introduction of CSTD associated with an extension of the beyond-use date (BUD) of cancer vials. A secondary objective was to estimate the level of minimization of drug wastage. MATERIALS AND METHODS: This was a prospective, single-center study with two periods of two months each. The cost of drugs saved by using conventional systems (syringe and needle) without a closed system in the first period was compared to the cost of drugs saved by using the CSTD Chemoclave® system in the second period. The drug waste minimization rate compared actual drug waste to potential waste in Period 2. RESULTS: In Period 1, the amount of drug saved accounted for an average of 10.3% of the amount used in milligrams and the amount of drug wasted accounted for an average of 18.7%. In period 2, these proportions were 15.2% and 6.4% respectively. The CSTD generated an extra cost of 11,962.5 USD compared to the conventional system. The drug saved cost related only to the CSTD and the acquisition cost of the CSTD was a deficit of -7,444.95 USD and the cost saved from the compounding (CSTD and syringes) was a gain of 1,722.01 USD. The waste minimization represented an average of 72.5% ± 24.4% of potential waste. CONCLUSION: The use of CSTD to extend the BUD allowed to reduce waste due to microbiological instability without adding an economic profit.

Chemometric Analysis of UV-Visible Spectral Fingerprints for the Discrimination and Quantification of Clinical Anthracycline Drug Preparation Used in Oncology.

In clinical treatment, the analytical quality assessment of the delivery of chemotherapeutic preparations is required to guarantee the patient's safety regarding the dose and most importantly the appropriate anticancer drug. On its own, the development of rapid analytical methods allowing both qualitative and quantitative control of the formulation of prepared solutions could significantly enhance the hospital's workflow, reducing costs, and potentially providing optimal patient care. UV-visible spectroscopy is a nondestructive, fast, and economical technique for molecular characterization of samples. A discrimination and quantification study of three chemotherapeutic drugs doxorubicin, daunorubicin, and epirubicin was conducted, using clinically relevant concentration ranges prepared in 0.9% NaCl solutions. The application of the partial least square discriminant analysis PLS-DA method on the UV-visible spectral data shows a perfect discrimination of the three drugs with a sensitivity and specificity of 100%. The use of partial least square regression PLS shows high quantification performance of these molecules in solution represented by the low value of root mean square error of calibration (RMSEC) and root mean square error of cross validation (RMSCECV) on the one hand and the high value of R-square on the other hand. This study demonstrated the viability of UV-visible fingerprinting (routine approach) coupled with chemometric tools for the classification and quantification of chemotherapeutic drugs during clinical preparation.

Risk reduction in a cancer chemotherapy production unit: Contribution of an automated drug dispensing system.

OBJECTIVE: The purpose of our study was to evaluate the contribution of an automated drug dispensing system in securing cancer chemotherapy production process at the pharmacy of the National Institute of Oncology in Rabat. METHODS: The failure modes and effects analysis method was applied to the chemotherapy production process in two phases: Phase 1, using an open shelf for storage then phase 2, using an automated drug dispensing system. The failure modes were defined and their criticality indexes was calculated on the basis of the likelihood of occurrence, the potential severity for the patients and/or the impact on the process and the detection probability. The criticality indexes of the two phases were prioritized and compared. RESULTS: We identified 35 failure modes for phase 1 and 37 for phase 2. The sum of criticality indexes was 5957 and 4586, respectively, for phase 1 and phase 2, corresponding to a criticality reduction of -23%. The greatest improvements concerned that the needed drug is missing during the picking, storage of potential expired drugs, and double compounding. CONCLUSION: Our study highlighted the contribution of automated drug dispensing system in risk minimization. The use of automated drug dispensing system is a part of security improvement in chemotherapy production unit.