Pharmacists role in cost saving and waste minimization study on antineoplastic drugs: A multi-central study in Turkey

Year 2025, Volume: 29 Issue: 3, 1248 - 1255, 04.06.2025

Ozge Kanmaz , Caglar Macit , İpek Eroğlu , Barkın Berk

https://doi.org/10.12991/jrespharm.1651278

Abstract

Cancer diseases are the most common cause of death and chemotherapeutics used in cancer treatment have an important place in the budget allocated to health due to their high costs. This study aims to reduce disposal costs and reduce chemotherapy drug expenses through cost savings. Our study was conducted between November 2017 and July 2018 (1st semester) and between August 2018 and April 2019 (2nd semester) in three hospitals using a common chemotherapy drug preparation center. Chemotherapy sessions were rearranged in accordance with the drugs included in the treatment plans to reduce drug costs. The drug quantities billed through hospital automation programs and the disposal costs of unused drugs were reported by the pharmacists on a milligram (mg) basis. The obtained data was analyzed by the GraphPad Prism program. P<0.05 was considered significant. While the total amount of waste medicine in the 1st. period was reported as 371,866 mg, it was reported as 303,056 mg in the 2nd. period (p<0.05). While the total disposal cost was calculated at € 87,867.02 in the 1st. period, it was calculated € 26,392.48 in the 2nd. period under the control of pharmacists (p<0.01). In this study, it was observed that providing and monitoring drug preparation services by well-equipped pharmacists specialized in the field of oncology gave positive results in terms of reducing both drug expenditures and drug disposal costs. Further studies are needed to determine the safety of chemotherapy pharmacists and patients.

Keywords

Pharmacists , waste management , antineoplastic drugs , drug disposal cost , pharmacoeconomics

Ethical Statement

Ethical approval was obtained from the Local Ethics Committee of S.B.Ü. İstanbul Training and Research Hospital (27 June 2019 / E.1974).

References

• [1] Yabroff KR, Lund J, Kepka D, Mariotto A. Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol Biomarkers Prev. 2011; 20(10): 2006-2014. https://doi.org/10.1158/1055-9965.EPI-11-0650
• [2] IARC, International Agency for Research on Cancer. 2024. https://gco.iarc.who.int/tomorrow/en/dataviz/tables?years=2050&populations=903_904_905_908_909_935_900&types=0 (accessed on 11 January 2025).
• [3] IARC, International Agency for Research on Cancer. 2024. https://gco.iarc.who.int/tomorrow/en/dataviz/tables?years=2050&populations=903_904_905_908_909_935_900&types=1 (accessed on 11 January 2025).
• [4] Leighl NB, Nirmalakumar S, Ezeife DA, Gyawali B. An Arm and a Leg: The Rising Cost of Cancer Drugs and Impact on Access. Am Soc Clin Oncol Educ Book. 2021; 41: 1-12. https://doi.org/10.1200/EDBK_100028
• [5] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [published correction appears in CA Cancer J Clin. 2020;70(4):313. doi: 10.3322/caac.21609]. CA Cancer J Clin. 2018; 68(6): 394-424. https://doi.org/10.3322/caac.21492
• [6] Tan SC, Poh WT, Yong ACH, Chua EW, Ooi J, Mahmud R, Thiagarajan M, Stanslas J. Challenges and Strategies for Improving Access to Cancer Drugs in Malaysia: Summary of Opinions Expressed at the 2nd MACR International Scientific Conference 2022. Cancer Manag Res. 2023; 15: 851-862. https://doi.org/10.2147/CMAR.S420890
• [7] Groenland SL, Mathijssen RHJ, Beijnen JH, Huitema ADR, Steeghs N. Individualized dosing of oral targeted therapies in oncology is crucial in the era of precision medicine. Eur J Clin Pharmacol. 2019; 75(9): 1309-1318. https://doi.org/10.1007/s00228-019-02704-2
• [8] Daher M. PhD Thesis. Enhancing Pharmaceutical Waste Management: Insights from Pharmacists' Perspectives on the Drug Take-Back Program. Rochester Institute of Technology, 2024.
• [9] Gursoy K. An Analysis of Public Pharmaceutical Policy, Pricing and Spending in Turkey. J Soc Secur. 2016; 6(1): 225-243.
• [10] Onkoloji Alanında Uygulama Rehberlerinin Oluşturulması, Kullanımının Yaygınlaştırılması ve İzlenmesi Çalışma Grubu Üyeleri, Antineoplastik İlaçlarin Güvenli Kullanim Standartlari Rehberi, Ankara, Türkiye 2009. https://klinika.medicine.ankara.edu.tr/docs/ilachazir.pdf
• [11] Soteriades ES, Economidou SC, Tsivitanidou A, Polyviou P, Lorimer AR, Katodritis N, Theophanous-Kitiri S. Environmental assessment of cytotoxic drugs in the Oncology Center of Cyprus. PLoS One. 2020;15(3):e0216098. https://doi.org/10.1371/journal.pone.0216098.
• [12] Yamada H, Kobayashi R, Shimizu S, Yamada Y, Ishida M, Shimoda H, Kato-Hayashi H, Fujii H, Iihara H, Tanaka H, Suzuki A. Implementation of a standardised pharmacist check of medical orders prior to preparation of anticancer drugs to reduce drug wastage. Int J Clin Pract. 2020; 74(4): e13464. https://doi.org/10.1111/ijcp.13464.
• [13] da Rocha C, Carlotto J, Zanis Neto J. Analysis of the interventions in antineoplastic therapy by a clinical pharmacy service at a tertiary hospital in Brazil. J Oncol Pharm Pract. 2022; 28(5): 1049–1055. https://doi.org/10.1177/10781552211017650.
• [14] Han JM, Ah YM, Suh SY, Jung SH, Hahn HJ, Im SA, Lee JY. Clinical and economic impact of pharmacists' intervention in a large volume chemotherapy preparation unit. Int J Clin Pharm. 2016; 38(5): 1124–1132. https://doi.org/10.1007/s11096-016-0339-9.
• [15] Francis SM, Heyliger A, Miyares MA, Viera M. Potential cost savings associated with dose rounding antineoplastic monoclonal agents. J Oncol Pharm Pract. 2015; 21(4): 280–284. https://doi.org/10.1177/1078155214533369.
• [16] National Cancer Institute. Cancer Statistics 2024. https://www.cancer.gov/about-cancer/understanding/statistics (accessed on 20 January 2025).
• [17] Jyoti K, Manjula G, Ganachari MS. Application of KW-ANOVA statistics to generate evidence for cytotoxic drug wastage induced financial burden among cancer patients: A clinical pharmacist observation. J Oncol Pharm Pract. 2020; 26(7): 1559-1565. https://doi.org/10.1177/1078155219898710.
• [18] Shah V, Spence A, Bartels T, Betcher J, Soefje S. Decreasing drug waste, reducing drug costs, and improving workflow efficiency through the implementation of automated chemotherapy dose rounding rules in the electronic health record system. Am J Health Syst Pharm. 2022; 79(8): 676-682. https://doi.org/10.1093/ajhp/zxab479.
• [19] Iihara H, Ishihara M, Matsuura K, Kurahashi S, Takahashi T, Kawaguchi Y, Yoshida K, Itoh Y. Pharmacists contribute to the improved efficiency of medical practices in the outpatient cancer chemotherapy clinic. J Eval Clin Pract. 2012; 18(4): 753-760. https://doi.org/10.1111/j.1365-2753.2011.01665.x.
• [20] Zecchini C, Vo TH, Chanoine S, Lepelley M, Laramas M, Lemoigne A, Allenet B, Federspiel I, Bedouch P. Clinical, economic and organizational impact of pharmacist interventions on injectable antineoplastic prescriptions: a prospective observational study. BMC Health Serv Res. 2020; 20(1): 113. https://doi.org/10.1186/s12913-020-4963-7.
• [21] Nerich V, Borg C, Villanueva C, Thiery-Vuillemin A, Helias P, Rohrlich PS, Demarchi M, Pivot X, Limat S. Economic impact of prescribing error prevention with computerized physician order entry of injectable antineoplastic drugs. J Oncol Pharm Pract. 2013; 19(1): 8-17. https://doi.org/10.1177/1078155212447974
• [22] Hatoum HT, Hutchinson RA, Witte KW, Newby GP. Evaluation of the contribution of clinical pharmacists: inpatient care and cost reduction. Drug Intell Clin Pharm. 1988; 22(3): 252-259. https://doi.org/10.1177/106002808802200318
• [23] Nesbit TW, Shermock KM, Bobek MB, Capozzi DL, Flores PA, Leonard MC, Long JK, Militello MA, White DA, Barone LD, Goldman MP, Kvancz DA. Implementation and pharmacoeconomic analysis of a clinical staff pharmacist practice model. Am J Health Syst Pharm. 2001; 58(9): 784-790. https://doi.org/10.1093/ajhp/58.9.784
• [24] Baudouin A, Herledan C, Poletto N, Guillemin MD, Maison O, Garreau R, Chillotti L, Parat S, Ranchon F, Rioufol C. Economic impact of clinical pharmaceutical activities in hospital wards: A systematic review. Res Social Adm Pharm. 2021; 17(3): 497-505. https://doi.org/10.1016/j.sapharm.2020.07.016
• [25] Ranchon F, Salles G, Späth HM, Schwiertz V, Vantard N, Parat S, Broussais F, You B, Tartas S, Souquet PJ, Dussart C, Falandry C, Henin E, Freyer G, Rioufol C. Chemotherapeutic errors in hospitalised cancer patients: attributable damage and extra costs. BMC Cancer. 2011; 11: 478. https://doi.org/10.1186/1471-2407-11-478
• [26] Gilbar PJ, Chambers CR, Musicco F. Preventing drug vial wastage and reducing expenditure associated with injectable cancer drugs: International oncology pharmacy survey. J Oncol Pharm Pract. 2022; 28(6): 1332-1339. https://doi.org/10.1177/10781552211024723
• [27] Kaya M, Nakamura K, Nagamine M, Suyama Y, Nakajo M, Uchida R, Hagikura K, Kanda A, Sugiyama K, Sugiyama R, Nakagaki S, Kimura M. A retrospective study comparing interventions by oncology and non-oncology pharmacists in outpatient chemotherapy. Cancer Rep (Hoboken). 2021; 4(4): e1371. https://doi.org/10.1002/cnr2.1371