Treatment time, ease of use and cost associated with use of Equashield™, PhaSeal^®, or no closed system transfer device for administration of cancer chemotherapy to a dog model

Abstract

This prospective experimental simulation study evaluated the efficiency, ease of use (EOU) and cost of administering chemotherapy with two closed system transfer devices (CSTD, Equashield™ and PhaSeal ) and no CSTD. Forty-six veterinary technicians (VT) working in oncology specialty practices were timed during chemotherapy administration simulated with water and a model canine limb 10 times with each system and with no CSTD. EOU and likelihood of recommending each system were rated by VT using visual analog scales. Costs were obtained from veterinary distributors. Administration was fastest with Equashield™ (P = 0.0003), but the difference was not enough to affect case flow. Equashield™ was easier to use than PhaSeal or no CSTD (P = 0.002), however VT recommended both CSTD more strongly than no CSTD (P < 0.0001). Equashield™ cost less than PhaSeal but was sold only in bulk quantities. CSTD did not decrease efficiency in administering chemotherapy and were readily accepted by VT.

Review of economic data on closed system transfer drug for preparation and administration of hazardous drugs

“…A total of 12 studies were included (figure 1)10 11 18–27: 10 original articles, one thesis and one poster presentation. Studies were conducted in six countries: USA (n=4), Spain (n=3), France (n=2), Malaysia (n=1), Hungary (n=1) and Turkey (n=1).…”

“…Studies were conducted in six countries: USA (n=4), Spain (n=3), France (n=2), Malaysia (n=1), Hungary (n=1) and Turkey (n=1). All but one of the studies took place in a hospital setting; the single exception was conducted in a veterinary setting 23. The PhaSeal device (Becton Dickinson) was the CSTD most frequently evaluated (in nine of the 12 studies).…”

ACVIM small animal consensus statement on safe use of cytotoxic chemotherapeutics in veterinary practice

“…Additional concerns in veterinary medicine include increased client costs and the perception that safety practices can decrease efficiency. Although there are costs associated with using appropriate safety equipment, their use does not impede workflow and educated veterinary technical staff are willing to use protective practices . All of the aforementioned obstacles should be considered and addressed during training.…”

“…Although there are costs associated with using appropriate safety equipment, their use does not impede workflow and educated veterinary technical staff are willing to use protective practices. 46 All of the aforementioned obstacles should be con- Written policies and procedures for the safe handling of HD must be in place in any facility in which HD are handled. 47 A key element of the safety program is the availability of Safety Data Sheets…”

Overcoming Challenges of Implementing Closed System Transfer Device Clinical In-Use Compatibility Testing for Drug Development of Antibody Drug Conjugates

“…The critical components of the CSTD can be broken into 3 categories as shown in Table 2: the type of containment system, the type of syringe adapter, and the type of vial spike. In addition to reports that the additional complexity can increase treatment time, [24][25][26] there is an unknown risk of increased manipulation during compounding and administration as well as potential impacts on drug product quality attributes and beyond use dates. Although there are many publications describing the effectiveness of marketed CSTD to serve as a containment barrier, an evaluation of their impact on drug product quality attributes and delivery efficiencies has yet to be reported.…”