title: Drug waste minimisation and cost-containment in Medical Oncology: two-year results of a feasibility study.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medical Oncology, University Hospital of Udine, 33100 Udine, Italy. fasola.gianpiero@aoud.sanita.fvg.it
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Fasola
authors.forename: Marianna
authors.initials: M
authors.lastname: Aita
authors.forename: Luisa
authors.initials: L
authors.lastname: Marini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Follador
authors.forename: Marina
authors.initials: M
authors.lastname: Tosolini
authors.forename: Laura
authors.initials: L
authors.lastname: Mattioni
authors.forename: Mauro
authors.initials: M
authors.lastname: Mansutti
authors.forename: Andrea
authors.initials: A
authors.lastname: Piga
authors.forename: Silvio
authors.initials: S
authors.lastname: Brusaferro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aprile
mesh_terms: D003363:Cost Control / Q000379:methods*; D004358:Drug Therapy / Q000706:statistics & numerical data; D005240:Feasibility Studies; D006801:Humans; D008495:Medical Oncology; D004364:Pharmaceutical Preparations / Q000191:economics / Q000592:standards*; D010607:Pharmacy Service, Hospital / Q000191:economics*; D012037:Refuse Disposal / Q000706:statistics & numerical data*; D013997:Time Factors
chemical_list: D004364:Pharmaceutical Preparations