Drug waste minimization as an effective strategy of cost-containment in oncology

Abstract

Background: Sustainability of cancer care is a crucial issue for health care systems worldwide, even more during a time of economic recession. Low-cost measures are highly desirable to contain and reduce expenditures without impairing the quality of care. In this paper we aim to demonstrate the efficacy of drug waste minimization in reducing drug-related costs and its importance as a structural measure in health care management.

Methods: We first recorded intravenous cancer drugs prescription and amount of drug waste at the Oncology Department of Udine, Italy. Than we developed and applied a protocol for drug waste minimization based on per-pathology/per-drug scheduling of chemotherapies and pre-planned rounding of dosages.

Results: Before the protocol, drug wastage accounted for 8,3% of the Department annual drug expenditure. Over 70% of these costs were attributable to six drugs (cetuximab, docetaxel, gemcitabine, oxaliplatin, pemetrexed and trastuzumab) that we named 'hot drugs'. Since the protocol introduction, we observed a 45% reduction in the drug waste expenditure. This benefit was confirmed in the following years and drug waste minimazion was able to limit the impact of new pricely drugs on the Department expenditures.

Conclusions: Facing current budgetary constraints, the application of a drug waste minimization model is effective in drug cost containment and may produce durable benefits.

Figure 1

Pemetrexed waste cost compared to its prescription.

Figure 2

Trastuzumab waste cost compared to its prescription.

Figure 3

Comparison between iv Drug Costs and Waste Costs after the application of the protocol.

Figure 4

Waste Costs observed and estimated without the protocol adoption.

Figure 5

Comparison between Observed Waste Costs and Estimated Waste Costs without the protocol.