Introduction Febrile neutropenia (FN) is one of the dose-limiting adverse effects of chemotherapy. Granulocyte-Colony Stimulating Factors (G-CSFs) minimize the incidence of FN and reduce the risk of neutropenia complications. This study was conducted to address the prescription pattern of G-CSF for primary prophylaxis of FN during the first cycle of chemotherapy in solid tumors. Method This prospective observational study was done to investigate the G-CSF prescription pattern in patients receiving the first cycle of chemotherapy for solid tumors and compare it with the NCCN guideline recommendations. Result Based on the guideline, prophylactic G-CSF administration was indicated in 26 of the 96 patients (27.1%) and all of them received G-CSF. On the other hand, 70 patients (72.9%) did not meet the guideline criteria for prophylaxis, but 60 (62.5%) of them received G-CSF. Seven doses of pegfilgrastim and 165 doses of filgrastim were used inappropriately in the study population, which was associated with an economic burden of about 224.7 million IRR (5350 USD). Conclusion Taken together, inconsistencies with the guideline were observed in this prospective evaluation, suggesting that submitting rationalized policies to decrease G-CSF prescription, especially in patients with a lower or intermediate FN risk, yields substantial cost savings.

This study clarified the effect of pharmacist‐led interventions to decrease the cost and inappropriate prescribing of parenteral paracetamol (PP). The prescribing pattern of PP was assessed at baseline and after pharmacist‐led interventions (educational and protocol interventions) in a teaching hospital in Tehran, Iran. Comparison of appropriate dosage form between baseline and postintervention assessments indicated a significant difference (55.6% vs 77.6%, respectively; p < 0.001). Educational intervention significantly improved the appropriate duration of PP administration from baseline to postintervention (29% vs 41.7%, respectively; p = 0.006), but had no significant effect on the appropriateness of dosing. The mean monthly number of vials used decreased considerably following the educational and protocol interventions (25% (p = 0.002) and 59% (p < 0.001) reductions, respectively). Thus, incorporating educational and protocol interventions could promote the appropriate prescription and rational use of PP and aid in reducing its financial burden.

Islamic Republic of)Objectives: Cancer is one of the major causes of mortality and represents a significant burden of disease. Due to the complexity of chemotherapy regimens, medication errors can occur at any point from prescribing to administration. Today, pharmacists play an important role in rationalizing consumption and prescription of medicines for patients undergoing chemotherapy. Intervention of the pharmacist, as one of the last members of the treatment team, can reduce adverse drug events (ADEs) and ultimately save costs. This study estimated the cost-benefit ratio of pharmacist interventions over a year in a chemotherapy preparation unit at a referral hospital in Iran in which annually about 10,000 cancer patients receive inpatient and outpatient care. Methods: Pharmacist intervention records from Sep 2017 to Aug 2018 collected in a standard checklist in Cancer Institute, Tehran University of Medical Sciences, Iran.The clinical significance of interventions was rated by one oncologist and one clinical pharmacist according to Common Terminology Criteria for Adverse Event (CTCAE). Benefit was estimated through both cost avoidance based on the potential to avoid an ADE and cost savings related to reducing discarded products. Cost was estimated from the pharmacists' salary corresponding to the time spent in reviewing chemotherapy prescriptions. Finally, the analysis was conducted by calculation of the cost-benefit ratio. Results: Among 18,450 cancer chemotherapy prescriptions, 559 interventions were applied. Most cases of interventions were related to dosage adjustment of the prescribed dosage (36.4%). 78% of the interventions were considered as clinically more than significant. The cost-benefit analysis showed a clear cost benefit with a cost-benefit ratio of 2.3-16.6 (depends on clinical significance):1. Conclusions: Positive impact of pharmacists' interventions on the clinical and economic outcomes of chemotherapy drugs was clearly demonstrated in this study. This service could reduce medication errors, preventable ADEs, as well as costs of both medications and potential ADEs.