Research article

Drug waste minimisation and cost-containment in Medical Oncology: Two-year results of a feasibility study

Gianpiero Fasola¹ , Marianna Aita¹ , Luisa Marini¹ , Alessandro Follador¹ , Marina Tosolini² , Laura Mattioni² , Mauro Mansutti¹ , Andrea Piga¹ , Silvio Brusaferro³ and Giuseppe Aprile¹

¹  Department of Medical Oncology, University Hospital of Udine, 33100 Udine, Italy

²  Unit of Pharmacy, University Hospital of Udine, 33100 Udine, Italy

³  Department of Experimental and Clinical Pathology and Medicine, University Hospital of Udine, 33100 Udine, Italy

author email corresponding author email

BMC Health Services Research 2008, 8:70doi:10.1186/1472-6963-8-70

Published:	1 April 2008

Abstract

Background

Cost-containment strategies are required to face the challenge of rising drug expenditures in Oncology. Drug wastage leads to economic loss, but little is known about the size of the problem in this field.

Methods

Starting January 2005 we introduced a day-to-day monitoring of drug wastage and an accurate assessment of its costs. An internal protocol for waste minimisation was developed, consisting of four corrective measures: 1. A rational, per pathology distribution of chemotherapy sessions over the week. 2. The use of multi-dose vials. 3. A reasonable rounding of drug dosages. 4. The selection of the most convenient vial size, depending on drug unit pricing.

Results

Baseline analysis focused on 29 drugs over one year. Considering their unit price and waste amount, a major impact on expense was found to be attributable to six drugs: cetuximab, docetaxel, gemcitabine, oxaliplatin, pemetrexed and trastuzumab. The economic loss due to their waste equaled 4.8% of the annual drug expenditure. After the study protocol was started, the expense due to unused drugs showed a meaningful 45% reduction throughout 2006.

Conclusion

Our experience confirms the economic relevance of waste minimisation and may represent a feasible model in addressing this issue.

A centralised unit of drug processing, the availability of a computerised physician order entry system and an active involvement of the staff play a key role in allowing waste reduction and a consequent, substantial cost-saving.