title: Ideal vial size for bortezomib: real-world data on waste and cost reduction in treatment of multiple myeloma in Brazil.
abstract: OBJECTIVE
  Single-size vials of drugs may be a source of waste and increase in treatment costs. Bortezomib, indicated for multiple myeloma (MM) treatment, is available in 3.5-mg vials, a quantity higher than the average dose commonly prescribed. This analysis aimed to demonstrate, through real-world data, which would be the optimal vial presentation for bortezomib in Brazil and quantify the reduction in medication waste related to this option.
  
  
  METHODS
  From November 2007 to October 2009 all patients with MM treated with bortezomib were identified via the Evidências database. Analysis of prescribed, dispensed, and wasted doses, their costs and projections of the ideal vial size were performed.
  
  
  RESULTS
  Thirty-five patients (mean body surface area of 1.73 m(2)) received 509 infusions in 131 cycles of treatment (average of 3.77 cycles per patient). The average dose prescribed was 2.1 mg per infusion (95% confidence interval [CI] 1.97-2.26) with average waste of 39.5% of the vial content (95% CI 35.35-43.76). The mean waste per patient per day was 1.38 mg (95% CI 1.24-1.52). If a 3-mg vial were available, the average drug waste per patient per day would be 0.88 mg (95% CI 0.74-1.03) or 36.2% less. With a 2.5-mg vial the waste would be 1.05 mg (95% CI 0.81-1.29) or 23.9% less. If two presentations were available (2.5 mg and 0.5 mg), the waste would be 0.52 mg (95% CI 0.4-0.63) or 62.5% less. Considering the price of the different vials to be proportional to the original 3.5-mg vial, the cost would be also reduced by the same rates described above.
  
  
  CONCLUSIONS
  A simple adjustment in vial size may reduce the waste of bortezomib by 36% to 62% and can also reduce the cost of treatment.
authors.affiliation: Evidências, Campinas, Brazil. luciana.clark@evidencias.com.br
authors.forename: Luciana
authors.initials: L
authors.lastname: Clark
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Castro
authors.forename: Anna Flávia
authors.initials: AF
authors.lastname: Fortes
authors.forename: Fábio
authors.initials: F
authors.lastname: Santos
authors.forename: Otávio
authors.initials: O
authors.lastname: Clark
authors.forename: Tobias
authors.initials: T
authors.lastname: Engel
authors.forename: Bruna
authors.initials: B
authors.lastname: Pegoretti
authors.forename: Vanessa
authors.initials: V
authors.lastname: Teich
authors.forename: Denizar
authors.initials: D
authors.lastname: Vianna
authors.forename: Fabíola
authors.initials: F
authors.lastname: Puty
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics*; D001897:Boronic Acids / Q000008:administration & dosage / Q000191:economics*; D000069286:Bortezomib; D001938:Brazil; D017046:Cost Savings; D016527:Drug Costs; D004349:Drug Packaging / Q000191:economics*; D006302:Health Services Research; D006801:Humans; D008506:Medical Waste / Q000191:economics; D018803:Models, Economic; D009101:Multiple Myeloma / Q000188:drug therapy / Q000191:economics*; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011719:Pyrazines / Q000008:administration & dosage / Q000191:economics*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D001897:Boronic Acids; D008506:Medical Waste; D011719:Pyrazines; D000069286:Bortezomib