The Cost of Enfortumab Vedotin Wastage Due to Vial Size—A Real-World Analysis

Enfortumab Vedotin (EV) is FDA-approved for advanced urothelial cancer in patients previously treated with platinum-based chemotherapy and a checkpoint inhibitor. We conducted a real-world study to determine the extent of EV wastage in a single institution and assessed the financial impact of EV wastage annually in the United States. Systematic examination of the usage and wastage of all standard-of-care EV treatments administered to urothelial cancer patients at Memorial Sloan Kettering Cancer Center (MSKCC) between 1 January 2020 and 31 December 2020 was performed. Drug wastage was calculated by subtracting the actual administered dose from the total dose in an optimal set of vials. We built a pharmacoeconomic model to assess the financial impact of EV wastage annually in the US using the January 2021 Average Sales Prices from the Centers for Medicare and Medicaid Services. Sixty-four patients were treated with standard-of-care EV, with a median of 11 doses per patient (range 1–28). Wastage occurred in 46% of administered doses (367/793), with a mean waste per dose of 2.9% (0–18%). The average drug wastage cost per patient was $3127 ($252/dose). The annual cost of EV wastage in the US is estimated to be $15 million based on wastage data from a single center in the US. In summary, EV wastage due to available vial sizes was 2.9%, which falls under acceptable thresholds. While the percentage of EV wastage is relatively low, waste-minimizing practices may reduce the financial toxicity for the individual patient and for society.

PHARMACOECONOMIC STUDY ON DRUG WASTAGE

Cost effective analysis are commonly used to evaluate the potential costs and benefits of health care services. They are often conducted under the assumption of no drug wastage which does not reflect the real world scenario. Cancer is a major health problem responsible for 9% deaths all over the world. Anti-cancer drugs are costlier than any other category drugs due to which the compliance to treatment is questionable. Cancer drug wastage occurs when a parenteral drug within a single-use vial is not fully administered to a patient because of body-weight or body surface-area based dose calculation in cancer chemotherapy. We conducted a prospective observational study in chemotherapy OPD where patients undergo I.V chemotherapy treatment. Data was collected for a period of three months on the drugs and its wastage. Analysis was done to find out drugs causing an increment in cost due to wastage.Our analysis showed that wastage incremented cost of treatment by an average of 3% which accounts for Rs 2,39,237.12 per annum without any added benefit. The drug with maximum cost of wastage was found to be oxaliplatin.9.43% increment in cost was due to oxaliplatin alone, the reason was concluded to be limited vial size.

Real-World Nivolumab Wastage and Leftover Drug Stability Assessment to Facilitate Drug Vial Optimization for Cost Savings

PURPOSE: Nivolumab dosage was initially selected on the basis of body weight, often resulting in leftover drug after sterile compounding. This study sought to investigate the real-world wastage of nivolumab and assess the long-term stability of leftover nivolumab within vials to facilitate drug vial optimization (DVO). METHODS: We collected all discarded vials after preparation from 17 regional hospitals in Japan over a 6-month period preceding the adoption of a fixed dose of 240 mg per administration. The actual amount of waste was measured for each preparation. Stability assessment was performed under different storage conditions. RESULTS: A total of 2,789 100-mg vials and 4,069 20-mg vials were collected. Overall, the drug cost associated with the expenditure of nivolumab alone was $12.1 million, whereas the total cost due to drug wastage was $0.735 million (rate of wastage, 6.1%). Furthermore, the immunoglobulin G concentrations of nivolumab remaining within vials, as well as binding activity to programmed death-1 protein, did not change significantly over 4 weeks of storage at either 4°C or room temperature. CONCLUSION: Significant drug wastage occurs during sterile preparation of nivolumab according to body weight–based dosing. Although nivolumab dosing has been changed to a fixed dose in Japan, body weight–based dosing is still applied in some other countries, as well as in combination therapy with ipilimumab. Our findings regarding the long-term stability of leftover nivolumab within the vials should motivate hospitals to implement DVO for cost savings.

Retrospective Evaluation on Patient Screening and Counseling Service on Direct-acting Antivirals Against Hepatitis C

Objective: Drug-drug interactions and risk of hepatitis B reactivation potentially affect treatment outcomes of direct-acting antivirals (DAA) against hepatitis C. A comprehensive pharmacist screening and counseling service was implemented in a Hong Kong hospital, which aims to optimize the efficacy and safety of DAA therapy while minimizing the risk of drug wastage. The objective of the service review is to explore potential roles of pharmacist in hepatitis C management. Design: We retrospectively evaluate all cases under service from June 2017 to September 2018. Main outcome measures: Outcomes measured include drug-related problems (DRP) identified, treatment discontinuation and failure rates. Results: There were 44 cases under provision of service, all completed therapy except 1 died from underlying disease. 25 DRPs, predominantly categorized as drug-drug interactions, were documented. The interactions commonly involved acid-lowering agents. 1 case was noted with inadvertently lengthening of treatment duration. No cases of treatment failure or hepatitis B reactivation were reported. Conclusion: The safety concerns and high cost of DAA have created a new challenge to healthcare providers. Comprehensive screening and counseling by pharmacists are valuable to ensure safe and effective use of DAA, hence reducing unnecessary drug wastage.

Application of KW-ANOVA statistics to generate evidence for cytotoxic drug wastage induced financial burden among cancer patients: A clinical pharmacist observation

Background Very little is known about the effects of drug wastage costs among cancer patients in terms of “financial toxicity” leading to poor health and nonhealth outcomes. But reducing this drug waste is an attractive strategy for cost-cutting with regard to improving the health-related quality of life of the cancer patients. Thus, the objective of the study was to determine drug wastage and to generate evidence for cytotoxic drug waste and financial burden among cancer patients. Methodology: On Ethics Committee approval, a prospective-observational study was conducted in cancer patients. The data were collected in data collection form. Daily monitoring was done to analyze the quantity of drug wastage which was interpreted using KW-ANOVA and further evidence was developed for corrective mitigation strategies applicable to intent drugs. Results Among 90 patients, 52 patients experienced drug wastage that includes 9 intent drugs which figured out unnecessary monetary units and quantity wastage that range from 80 to 50,000 INR and 10 to 500 mg, respectively. The median price value for cost of drug wastage was 237.30 INR. Conclusion The study generates evidence that concludes the mandatory requirement of implementation of drug wastage mitigation strategies for the drugs expected to cause wastage. Clinical pharmacist extensively contributes in oncology pharmacy practice setting to identify the intent drugs and to abate the drug wastage among medications intending to cause potential increment in drug expenditure among cancer patients on chemotherapy clinical pharmacist.