Optimization of resources by drug management: A multicentred web-administered study on the use of ipilimumab in Italy

Abstract

Objective: In a scenario of new expensive cancer therapies entering the market, strategies of optimisation and cost containment are crucial in oncology care. Better management of drug waste and centralization of drug preparation can be effective strategies to achieve these goals. The aim of this work is to describe the economic management of a high cost anticancer drug (ipilimumab) in some Italian reference centres. Methods: This was an observational, multicentred study in which economical and clinical data of 21 cancer centres (418 patients) were collected during the enrollment period from February 2013 to August 2014. The follow-up period ended in July 2015. Results: Participants purchased 10.7% more vials of ipilimumab than necessary for compounding. The results were variable among centres, and only five centres had a deviation lower than 5% between the drug purchased and the drug prescribed. Hospitals applying the drug day reached a statistically significant residual of drug effectively used compared to the amount prescribed (P ¼ 0.018). Consequently, the price for treating a model patient was significantly lower in those hospitals (median spare of 7456 euro per patient). Conclusions: This study demonstrated that the careful management of drug waste and the application of drug-day, through a proper selection of vial and the ability to use the leftover drug, can generate economic savings. However, tailoring the drug stock to clinical need is still an open issue which deserves further analysis.

Impact of Different Dosing Strategies of Nivolumab in Patients With Solid Tumors: Italian Single Center Analysis

“…These strategies minimized the drug left unutilized, thus drug waste could be considered close to zero. Our results corroborate the findings of similar experiences of other centres (25)(26)(27).…”

“…In particular, an Italian multicentre study published in 2018 highlighted that the costs of immunotherapy treatments were inferior in the hospitals where a drug day strategy was been routinely applied (27). Therefore, if we regard that hybrid strategy with cost minimization systems could save € 2.549.044,15 per 1000 patients, considering the current price of nivolumab in Italy, we could purchase about 331.475,18 mg of additional drug.…”

Preventing drug vial wastage and reducing expenditure associated with injectable cancer drugs: International oncology pharmacy survey

“…For expensive drugs, such as ipilimumab, where there may not be sufficient patients to justify vial sharing, an approach termed “drug days” can be employed. 8 This involves scheduling all patients on uncommon expensive drugs to be treated on the same day of the week. The National Health Service (NHS) in England recognises that reducing wastage in chemotherapy compounding is crucial.…”

Funds Reimbursement of High-Cost Drugs in Gastrointestinal Oncology: An Italian Real Practice 1 Year Experience at the National Cancer Institute of Naples

“…Interestingly, after including this professional figure in the multidisciplinary team, from March 2016 to February 2017, there was an increase in reimbursements at the Department of Abdominal Oncology of the National Cancer Institute of Naples; in fact, EUR 881.712,42 were reimbursed against the EUR 214.554,98 of 2015 (Figure 1 ) and that that increase was not attributable to the number of patients (Table 2 ).This was related to improvements of all activities related to AIFA registry management and reimbursement requests. Optimization of costs along with clinical efficacy is a goal of sanitary systems and many experiences in literature have already indicated strategies both in oncology and other therapeutic areas in order to achieve this objective: patients' selection ( 12 – 14 ), drug-days ( 15 – 17 ), monitoring of prescription appropriateness ( 18 – 20 ) and MEA ( 10 ).…”