Feasibility of an Individualized Dispensing Program for Patients Prescribed Oral Anticancer Drugs to Prevent Waste

Smale, E.M.; Vlijmen, Bas van; Colen, Hadewig B B; Heuvel, Michel van den; Desar, Ingrid M.E.; Bemt, Bart J F van den; Bekker, Charlotte L

doi:10.1200/op.22.00553

Cited by 6 publications

(5 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…34 Dispensing reduced quantities of OADs (eg, split filling or individualizing dispensing) prevented about onethird of OAD waste. [35][36][37][38] However, it has several limitations, including the burden of frequent pharmacy visits on patients and a considerable proportion of drug waste being unforeseen. 38 Complementing strategies, including the redispensing of unused drugs, could be required.…”

Section: Discussionmentioning

confidence: 99%

“…[35][36][37][38] However, it has several limitations, including the burden of frequent pharmacy visits on patients and a considerable proportion of drug waste being unforeseen. 38 Complementing strategies, including the redispensing of unused drugs, could be required. Although these measures attain a substantial waste reduction, they may benefit from extended stakeholder cooperation.…”

Section: Discussionmentioning

confidence: 99%

“…A set of waste-minimizing strategies throughout the pharmaceutical supply and use chain is therefore required to address drug waste, starting with waste prevention . Dispensing reduced quantities of OADs (eg, split filling or individualizing dispensing) prevented about one-third of OAD waste . However, it has several limitations, including the burden of frequent pharmacy visits on patients and a considerable proportion of drug waste being unforeseen .…”

Section: Discussionmentioning

confidence: 99%

“…Still, we observed considerable differences among medical centers, potentially associated with population differences and treatment types offered as well as variations in dispensing policies. Although research has shown OAD waste despite conservative dispensing policies, 38 abundant research needs to elicit the effects of concurrent waste-minimizing strategies. All of the scenarios considered by this study showed positive cost savings; so despite uncertainty regarding underlying factors, redispensing unused OADs was associated with reduced waste and cost savings for cancer therapies.…”

Section: Limitationsmentioning

confidence: 99%

See 3 more Smart Citations

Cost Savings and Waste Reduction Through Redispensing Unused Oral Anticancer Drugs

Smale,

van den Bemt,

Heerdink

et al. 2024

JAMA Oncol

Self Cite

View full text Add to dashboard Cite

ImportanceNew strategies targeting waste are required to improve financial and ecologic sustainability of expensive therapies, such as oral anticancer drugs, that frequently remain unused by patients. Redispensing unused oral anticancer drugs seems to be a promising strategy when drug quality is guaranteed.ObjectivesTo determine the waste reduction and net cost savings attained by redispensing oral anticancer drugs that go unused by patients compared with the standard practice of disposal.Design, Settings, and ParticipantsThe ROAD study was a prospective single-group intervention conducted in the outpatient pharmacies of 4 hospitals in the Netherlands from February 1, 2021, to February 1, 2023, with 12-month follow-up of each patient. Patients with cancer and who had a prescription for an oral anticancer drug that could be stored at room temperature were included. Of 2426 eligible patients, 602 did not consent and 601 did not respond. Data analyses were performed from August 25, 2022, to April 19, 2023.InterventionParticipants received oral anticancer drugs for use at home in special packaging (ie, sealed packaging with time-temperature indicator), to be returned to the pharmacy should these remain unused. The pharmacy ensured quality of returned drugs based on authenticity, appearance, remaining shelf life and adequate storage temperature. Drugs fulfilling quality requirements were redispensed to other patients.Main Outcome and MeasureTotal waste reduction and mean net annual cost savings per patient compared with the standard practice of disposal. Optimization of cost savings was explored by introducing variations in the quality assurance procedure and patient population. All analyses used the average exchange rate for 2021 €1 = US $1.18.ResultsOf 1223 patients with cancer who consented, 1071 participated (median [IQR] age, 70 [62-75] years; 622 [58.1%] were male). In all, 171 patients (16.0%; 95% CI, 13.8%-18.3%) returned 335 unused oral anticancer drug packages. Of the returned drugs, 228 packages were redispensed, which reduced waste by 68.1% (95% CI, 67.7%-68.5%) compared with the standard practice (disposal). Redispensing unused oral anticancer drugs comprised 2.4% (95% CI, 2.2%-2.5%) of total drug costs, providing mean net annual cost savings of US $680 (95% CI, $524-$837) up to $1591 (95% CI, $1226-$2002) per participant.Conclusions and RelevanceThe findings of this multicenter intervention study indicate that redispensing unused oral anticancer drugs is associated with waste reduction and cost savings, which in turn may improve the affordability and sustainability of cancer treatment.Trial RegistrationWorld Health Organization International Clinical Trials Registry Platform Identifier: NL9208

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Cost Savings and Waste Reduction Through Redispensing Unused Oral Anticancer Drugs

Smale,

van den Bemt,

Heerdink

et al. 2024

JAMA Oncol

Self Cite

View full text Add to dashboard Cite

show abstract

“…The primary study outcome was patient satisfaction and perceived usefulness of the proactive pathway, as assessed in the Patient Pathway Experience Survey. Following recommendations for sample size estimations for pilot studies [23][24][25] and mirroring similar pilot implementation studies, [26][27][28][29][30][31][32] a minimum of 50 answers to the overall survey were prespecified as needed to provide an initial assessment of patient experience/satisfaction. Pathway progression criteria were defined as at least 70% of the patients receiving the entire pathway reporting to be very satisfied or completely satisfied.…”

Section: Statistical and Qualitative Analysesmentioning

confidence: 99%

Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer

Franzoi,

Degousée,

Martin

et al. 2023

JCO Oncology Practice

View full text Add to dashboard Cite

PURPOSE Optimal comprehensive survivorship care is insufficiently delivered. To increase patient empowerment and maximize the uptake of multidisciplinary supportive care strategies to serve all survivorship needs, we implemented a proactive survivorship care pathway for patients with early breast cancer at the end of primary treatment phase. METHODS Pathway components included (1) a personalized survivorship care plan (SCP), (2) face-to-face survivorship education seminars and personalized consultation for supportive care referrals (Transition Day), (3) a mobile app delivering personalized education and self-management advice, and (4) decision aids for physicians focused on supportive care needs. A mixed-methods process evaluation was performed according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework including administrative data review, pathway experience survey (patient, physician, and organization), and focus group. The primary objective was patient-perceived satisfaction with the pathway (predefined progression criteria for pathway continuation ≥70%). RESULTS Over 6 months, 321 patients were eligible for the pathway and received a SCP and 98 (30%) attended the Transition Day. Among 126 patients surveyed, 77 (66.1%) responded. 70.1% received the SCP, 51.9% attended the Transition Day, and 59.7% accessed the mobile app. 96.1% of patients were very or completely satisfied with the overall pathway, whereas perceived usefulness was 64.8% for the SCP, 90% for the Transition Day, and 65.2% for the mobile app. Pathway implementation seemed to be positively experienced by physicians and the organization. CONCLUSION Patients were satisfied with a proactive survivorship care pathway, and the majority reported that its components were useful in supporting their needs. This study can inform the implementation of survivorship care pathways in other centers.

show abstract

Environmental Outcomes of Reducing Medication Waste by Redispensing Unused Oral Anticancer Drugs

Smale,

Ottenbros,

van den Bemt

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceMedications are associated with substantial environmental outcomes, yet frequently end up being unused by patients. Waste-minimizing interventions, such as redispensing of quality-approved oral anticancer drugs remaining unused by patients at home, could reduce the environmental footprint of cancer treatment.ObjectivesTo assess the environmental outcomes of redispensing quality-assured oral anticancer drugs and to explore how redispensing could be environmentally optimized.Design, Setting, and ParticipantsIn this quality improvement study, a cradle-to-grave life cycle assessment was performed in the outpatient pharmacy of 4 Dutch hospitals, based on a prospective multicenter trial comprising 1071 patients with a clinical diagnosis of cancer and an active prescription for an oral anticancer drug stored at room temperature from February 1, 2021, to February 1, 2023, with a follow-up of 12 months per patient.InterventionParticipants received prescribed oral anticancer drugs with additional quality-assurance materials (ie, seal bags and time-temperature indicators), so the pharmacy could redispense quality-assured drugs based on authenticity, appearance, remaining shelf life, and/or adequate storage.Main Outcomes and MeasuresThe estimated environmental outcomes avoided due to waste reduction (ie, production and transport and incineration of redispensed oral anticancer drugs) corrected for outcomes of process burdens (ie, quality assurance materials), quantified in 3 outcome measures: human health damage (disability-adjusted life-years), ecosystems damage (species × year), and climate change (kg of carbon dioxide equivalent [CO2-eq]) per patient per year.ResultsA volunteer sample of 1071 patients (median age, 70 years [IQR, 62-75 years]; 622 men [58.1%]) participated in the intervention. Redispensing oral anticancer drugs was initially associated with an environmental burden, mainly because of the high impact of time-temperature indicators. However, when quality-assurance materials were selectively used for temperature-sensitive oral anticancer drugs (ie, maximum storage temperature of 25 °C), redispensing was environmentally beneficial to human health and ecosystems, providing estimated climate benefits of 1.9 kg (95% CI, 1.4-2.6 kg) of CO2-eq per patient per year.Conclusions and RelevanceIn this quality improvement study, redispensing unused oral anticancer drugs was found to be a suitable strategy to reduce waste and improve environmental sustainability of cancer treatment after process optimization. Redispensing unused oral anticancer drugs could contribute to sustainability of cancer treatment through reduced costs and environmental outcomes.

show abstract

Feasibility of an Individualized Dispensing Program for Patients Prescribed Oral Anticancer Drugs to Prevent Waste

Cited by 6 publications

References 31 publications

Cost Savings and Waste Reduction Through Redispensing Unused Oral Anticancer Drugs

Cost Savings and Waste Reduction Through Redispensing Unused Oral Anticancer Drugs

Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer

Environmental Outcomes of Reducing Medication Waste by Redispensing Unused Oral Anticancer Drugs

Contact Info

Product

Resources

About