Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2024 Jan 1;10(1):87-94.
doi: 10.1001/jamaoncol.2023.4865.

Cost Savings and Waste Reduction Through Redispensing Unused Oral Anticancer Drugs: The ROAD Study

Elisabeth M Smale  1 , Bart J F van den Bemt  1   2 , Eibert R Heerdink  3   4   5 , Ingrid M E Desar  6 , Toine C G Egberts  3   4 , Charlotte L Bekker  1 ; ROAD Study Group
Collaborators, Affiliations
Multicenter Study

Cost Savings and Waste Reduction Through Redispensing Unused Oral Anticancer Drugs: The ROAD Study

Elisabeth M Smale et al. JAMA Oncol. .

Erratum in

  • Change in email address.
    [No authors listed] [No authors listed] JAMA Oncol. 2025 Feb 1;11(2):189. doi: 10.1001/jamaoncol.2024.6289. JAMA Oncol. 2025. PMID: 39699887 Free PMC article. No abstract available.

Abstract

Importance: New strategies targeting waste are required to improve financial and ecologic sustainability of expensive therapies, such as oral anticancer drugs, that frequently remain unused by patients. Redispensing unused oral anticancer drugs seems to be a promising strategy when drug quality is guaranteed.

Objectives: To determine the waste reduction and net cost savings attained by redispensing oral anticancer drugs that go unused by patients compared with the standard practice of disposal.

Design, settings, and participants: The ROAD study was a prospective single-group intervention conducted in the outpatient pharmacies of 4 hospitals in the Netherlands from February 1, 2021, to February 1, 2023, with 12-month follow-up of each patient. Patients with cancer and who had a prescription for an oral anticancer drug that could be stored at room temperature were included. Of 2426 eligible patients, 602 did not consent and 601 did not respond. Data analyses were performed from August 25, 2022, to April 19, 2023.

Intervention: Participants received oral anticancer drugs for use at home in special packaging (ie, sealed packaging with time-temperature indicator), to be returned to the pharmacy should these remain unused. The pharmacy ensured quality of returned drugs based on authenticity, appearance, remaining shelf life and adequate storage temperature. Drugs fulfilling quality requirements were redispensed to other patients.

Main outcome and measure: Total waste reduction and mean net annual cost savings per patient compared with the standard practice of disposal. Optimization of cost savings was explored by introducing variations in the quality assurance procedure and patient population. All analyses used the average exchange rate for 2021 €1 = US $1.18.

Results: Of 1223 patients with cancer who consented, 1071 participated (median [IQR] age, 70 [62-75] years; 622 [58.1%] were male). In all, 171 patients (16.0%; 95% CI, 13.8%-18.3%) returned 335 unused oral anticancer drug packages. Of the returned drugs, 228 packages were redispensed, which reduced waste by 68.1% (95% CI, 67.7%-68.5%) compared with the standard practice (disposal). Redispensing unused oral anticancer drugs comprised 2.4% (95% CI, 2.2%-2.5%) of total drug costs, providing mean net annual cost savings of US $680 (95% CI, $524-$837) up to $1591 (95% CI, $1226-$2002) per participant.

Conclusions and relevance: The findings of this multicenter intervention study indicate that redispensing unused oral anticancer drugs is associated with waste reduction and cost savings, which in turn may improve the affordability and sustainability of cancer treatment.

Trial registration: World Health Organization International Clinical Trials Registry Platform Identifier: NL9208.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Flow Diagram of Participants Modified for Single-Group Trial Design
OAD refers to oral anticancer drug. aData included in analysis up to exclusion.
See this image and copyright information in PMC

References

    1. Organisation for Economic Co-operation and Development Health Policy Studies . Pharmaceutical Innovation and Access to Medicines. 2018. Accessed October 16, 2023. doi:10.1787/9789264307391-en - DOI
    1. Lenzen M, Malik A, Li M, et al. . The environmental footprint of health care: a global assessment. Lancet Planet Health. 2020;4(7):e271-e279. doi:10.1016/S2542-5196(20)30121-2 - DOI - PubMed
    1. Whitmee S, Haines A, Beyrer C, et al. . Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation-Lancet Commission on Planetary Health. Lancet. 2015;386(10007):1973-2028. doi:10.1016/S0140-6736(15)60901-1 - DOI - PubMed
    1. Smale EM, Egberts TCG, Heerdink ER, van den Bemt BJF, Bekker CL. Waste-minimising measures to achieve sustainable supply and use of medication. Sustain Chem Pharm. 2021;20:100400. doi:10.1016/j.scp.2021.100400 - DOI
    1. National Academies of Sciences, Engineering and Medicine, Health and Medicine Division, Board on Health Care Services, Committee on Ensuring Patient Access to Affordable Drug Therapies . Making Medicines Affordable: A National Imperative. National Academies Press; 2017. - PubMed

Publication types

Substances