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Following the publication of a guideline on the safe handling of hazardous drugs (HDs) in Japan, the issue of costeffectiveness has been become a problem. We introduced the PhaSeal™ system in June 2015, a closed system drug transfer devices (CSTD) used for all outpatients, from preparation to administration. We retrospectively compared clinical outcomes before and after the introduction of CSTD of HDs included chemotherapy. Furthermore, we evaluated the medical fee income and the cost of providing CSTD between July and December 2015. The mean number of outpatient chemotherapy treatments per day before and after CSTD introduction was 15 ∓ 6 and 14 ∓ 5, respectively (P = 0.947). The mean preparation time by pharmacists before and after introduction was 21 ∓ 9 and 24 ∓ 9 minutes, respectively (P = 0.002). The mean time of nursing preparation before and after introduction was 29 ∓ 16 and 25 ∓ 14 minutes, respectively (P = 0.068). The mean time of patients waiting for chemotherapy before and after introduction was 36 ∓ 17 and 37 ∓ 17 minutes, respectively (P = 0.735). Based on the mean differences between the medical fee income and the cost of CSTD per month, we estimated that the annual cost associated with the introduction of CSTD for all outpatient to administer HDs was approximately JPY 21,000,000. After April 2016, we estimated that the amount of increase of the medical fee income of CSTD was approximately JPY 2,000,000 per year. These results suggest that the medical fee income should be increased so CSTD can be implemented for all outpatients.

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