Parenteral cytotoxic drug wastage at a tertiary hospital in Kuala Lumpur: How much and why?

Ang, Zen Yang; Cheah, Kit Yee; Abdullah, Nadiah B; Samsuri, Safawati B; Lee, Siao Hui; Yem, Andrew Wh; Sriraman, Malathi

doi:10.1177/1078155219891209

Cited by 8 publications

(11 citation statements)

References 18 publications

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“…In order to minimize this medication wastage, physicians and hospital pharmacists should carefully ensure that the medications are suitable for administration to the patient before preparation, especially high-priced medications such as anti-cancer agents. 20,21) Our study had some limitations. First, this study was conducted in a single center; therefore, our results may not be transferable to other hospitals in Japan.…”

Section: Discussionmentioning

confidence: 94%

Medication Wastage in a University Hospital in Japan

Ueki

Sanematsu

Kawano

et al. 2022

Biological & Pharmaceutical Bulletin

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Medication wastage is a global issue; however, there are few reports in Japanese hospitals. The purpose of this study was to clarify the situation of medication wastage at our university hospital. We investigated the numbers, costs, reasons, occurrence departments, and involvement of high-priced medications of medication wastage for two years. We analyzed 6730 cases and the total cost was 22782027 Japanese yen (JPY). The most common reasons for medication wastage were change or discontinuation of medication after preparation and breakage or contamination due to dropping. The highest cost was expired medications. The department with the highest number of cases was the hospital wards; however, the hospital pharmacy department accounted for the majority of the costs and most of the reasons were expired medications. Medication wastage of 50000 JPY or more per case was only 1.3% of the total but accounted for 70.7% of the cost and medication wastage of 100000 JPY or more per case was only 0.7% of the total but accounted for 58.6% of the cost. These findings indicate that expired medications in the hospital pharmacy department have the largest impact on medication wastage from the viewpoint of economic loss, and suggest the need for efforts on medication management focusing on high-priced medications. The challenge of minimizing medication wastage should be addressed from the perspectives of both hospital management and the effective use of resources.

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Section: Discussionmentioning

confidence: 94%

Medication Wastage in a University Hospital in Japan

Ueki

Sanematsu

Kawano

et al. 2022

Biological & Pharmaceutical Bulletin

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“…Furthermore, the total cost of discarded compounded anticancer drugs dropped from USD 14,247 before modification to USD 3252 afterward. Ang et al also reported that the total cost of parenteral cytotoxic wastage for returned chemotherapy regimens in 72 cases a year at a tertiary hospital was 2052 EUR [ 14 ]. It is important to note that the savings effect was affected by the type of anticancer drug discarded, although the average price of anticancer drugs has increased [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Taha et al reported that fever or infection is the second most common cause, after neutropenia, of chemotherapy delay/cancellation [ 13 ]. Ang et al also demonstrated in a retrospective study that the most common reason for withholding chemotherapy regimens is the presence of signs and symptoms of infection, such as fever [ 14 ]. Daily monitoring of infection in patients receiving chemotherapy is, therefore, important.…”

Section: Introductionmentioning

confidence: 99%

A pharmacist check of patients’ infection-related condition prior to drug preparation reduces anticancer drug wastage after mixing: a retrospective study

Yamada

Iihara

et al. 2023

J of Pharm Policy and Pract

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Background We previously reported that a standardized pharmacist check of medical orders related to the administration criteria of anticancer drugs prior to preparation of injectable anticancer drugs was useful for reducing drug wastage after mixing. To further reduce anticancer drug wastage after preparation, we added a pharmacist check of patients' infection-related condition to the previous protocol and assessed the effectiveness of the modified protocol for reducing injectable anticancer drug wastage. Methods In addition to the administration criteria of anticancer drugs, patients’ infection-related condition, which was based on a body temperature ≥ 37.5 °C or elevated C-reactive protein (CRP) or white blood cell (WBC) count from baseline, was added to pharmacists’ checklist of items used previously to prepare injectable anticancer drugs. We retrospectively compared the number, type and cost of anticancer drugs discarded after preparation and the reasons for discarding these drugs between pre- and post-protocol modification. Results The rate at which anticancer drugs were discarded after preparation was significantly reduced after introducing the modified protocol compared to the original protocol (0.288% [18/6253] vs. 0.095% [6/6331], P = 0.013). Furthermore, the number of cases for which mixed anticancer agents were discarded because of infection decreased from 11 (fever: n = 8; elevated CRP or WBC: n = 3) to one (elevated CRP: n = 1) a year. Conclusions In addition to the standard administration criteria of anticancer drugs, checking patients’ infection-related condition, defined by a body temperature ≥ 37.5 °C or elevated CRP or WBC from baseline, before mixing by the pharmacist is useful for reducing anticancer drug wastage after preparation.

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“…Other studies that only investigated wastage from the preparation phase reported a chemotherapy wastage of 4.4% 26 and 19.72% of the total available drug, 9 and 8.3% of the total expenditure. 7 Some that only investigated potential wastage from the administration phase reported a chemotherapy wastage of 0.46% 27 and 3.51% of the total expenditure. 28 Chemotherapy wastage in NCCS appears to be generally smaller, considering how chemotherapy wastage in this study encompasses both wastage in the preparation phase and potential wastage in the administration phase.…”

Section: Discussionmentioning

confidence: 99%

Quantifying chemotherapy wastage in an ambulatory cancer centre in Singapore

Chan

Leow

Poh

et al. 2023

J Oncol Pharm Pract

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Introduction To ensure the efficient use of chemotherapy drugs, chemotherapy wastage is an area that can be investigated. This study aims to quantify current parenteral chemotherapy wastage and estimate parenteral chemotherapy wastage when dose banding is executed, using a chemotherapy wastage calculator in an ambulatory cancer centre. The study also examines the variables that significantly predict the total cost of chemotherapy wastage, investigates the reasons for wastage, and explores opportunities to reduce wastage. Methods Data were collected from the pharmacy in National Cancer Centre Singapore over 9 months retrospectively. Chemotherapy wastage is the sum of wastage in the preparation phase and potential wastage in the administration phase. The calculator was created using Microsoft Excel and generated chemotherapy wastage in terms of cost and amount (mg) and analysed the reasons for potential wastage. Results The calculator reported a total of 2.22 million mg of chemotherapy wastage generated over 9 months, amounting to $2.05 million (Singapore Dollars, SGD). Regression analysis found that the cost of drug was the only independent variable that significantly predicted the total cost of chemotherapy wastage ( P = 0.004). The study also identified low blood count (625 [29.06%]) as the top reason for potential wastage and no-show ($128,715.94 [15.97%]) as the reason that incurred the highest cost of potential wastage. Conclusion The pharmacy has generated a considerable amount of chemotherapy wastage over 9 months. Interventions in both the preparation and administration phases are required to reduce chemotherapy wastage. The use of the chemotherapy wastage calculator in pharmacy operations could guide efforts to reduce chemotherapy wastage.

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Parenteral cytotoxic drug wastage at a tertiary hospital in Kuala Lumpur: How much and why?

Cited by 8 publications

References 18 publications

Medication Wastage in a University Hospital in Japan

Medication Wastage in a University Hospital in Japan

A pharmacist check of patients’ infection-related condition prior to drug preparation reduces anticancer drug wastage after mixing: a retrospective study

Quantifying chemotherapy wastage in an ambulatory cancer centre in Singapore

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