Optimization of resources by drug management: A multicentred web-administered study on the use of ipilimumab in Italy

Abstract

Objective: In a scenario of new expensive cancer therapies entering the market, strategies of optimisation and cost containment are crucial in oncology care. Better management of drug waste and centralization of drug preparation can be effective strategies to achieve these goals. The aim of this work is to describe the economic management of a high cost anticancer drug (ipilimumab) in some Italian reference centres.

Methods: This was an observational, multicentred study in which economical and clinical data of 21 cancer centres (418 patients) were collected during the enrollment period from February 2013 to August 2014. The follow-up period ended in July 2015.

Results: Participants purchased 10.7% more vials of ipilimumab than necessary for compounding. The results were variable among centres, and only five centres had a deviation lower than 5% between the drug purchased and the drug prescribed. Hospitals applying the drug day reached a statistically significant residual of drug effectively used compared to the amount prescribed (P = 0.018). Consequently, the price for treating a model patient was significantly lower in those hospitals (median spare of 7456 euro per patient).

Conclusions: This study demonstrated that the careful management of drug waste and the application of drug-day, through a proper selection of vial and the ability to use the leftover drug, can generate economic savings. However, tailoring the drug stock to clinical need is still an open issue which deserves further analysis.

Keywords: Drug compounding; ipilimumab; melanoma; sustainability; vial-sharing.

Figure 1.

Management of drug supply. (a) The percentage of vials for each size. (b) for each participant (ID), the ratio between the milligrams of ipilimumab purchased and prescribed (grey bars) and the ratio between the milligrams effectively used for compounding and prescribed (black bars). The percentages reported are normalised on the number of milligrams prescribed. Median frequencies of purchased/prescribed milligrams and used/prescribed milligrams are reported in the box plot of panel C. Boxes represent the 25th to 75th percentile of data, mean is represented as a dot, and median is represented as a line dividing the box. Comparison between medians was done using the Wilcoxon Rank Sum Test and the difference is considered statistically significant for P < 0.05.

Figure 2.

Evaluation of efficiency of vial use. (a) For each participant (ID), deviation between the amount of ipilimumab prescribed and actually used for compounding (ΔUP). This deviation is expressed as percentage normalised on the prescribed amount. Median deviations are reported (b) dividing the participants into who used the drug-day for optimization of resources and who did not. Boxes represent the 25th to 75th percentile of data, mean is represented as a dot, median is represented as a line dividing the box. Comparison between medians was done using the Wilcoxon Rank Sum Test and the difference is considered statistically significant for P < 0.05. (c) The cost for treating a model patient in hospitals which adopted and those that did not adopt the drug-day.