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Dose-rounding strategy of cancer agents results in potential cost, waste avoidance

13 Feb 2018

Significant cost and waste savings can be achieved by rounding monoclonal antibodies to the nearest vial size, with minimal deviation from the actual ordered dose, a recent study suggests.

Of the 436 doses included, 237 were not rounded to the nearest vial size and thus was excluded from the analysis. Using actual wholesale price, the cost of waste related to these doses was $108,013.64. On the other hand, cost savings associated with the theoretical dose calculations were estimated at $83,595.53.

Dose rounding to the nearest vial size led to a median deviation from the ordered dose of 6.7 percent (range, 1.4‒20 percent).

In one study that involved three costly cancer agents (bevacizumab, trastuzumab and cetuximab), a 10-percent dose reduction for all cases was achieved after consultation with key physicians regarding the proposed percent reduction. Implementation of a dose-rounding policy for these three agents represents a potentially substantial cost savings. [J Oncol Pharm Pract 2015;21:280-284]

A 2011 study by Winger and colleagues found that routine dose rounding of biologic anticancer agents to an amount within 10 percent of the ordered dose resulted in cost savings through reduction of drug wastage. [J Oncol Pharm Pract 2011;17:246-251]

The current study was a single-arm, retrospective chart review evaluating all monoclonal antibody doses dispensed at an outpatient community infusion centre associated with an academic medical centre between August 2014 and August 2015.The authors reviewed all monoclonal antibody doses to determine the cost of drug wasted using two methods.

The waste-cost analysis described the amount of drug disposed of due to the use of partial vials, while the theoretical dose savings described potential cost savings based on rounding the ordered dose to the nearest vial size. To explore clinical implications, a comparison was made between the theoretical rounded dose and the actual ordered dose.

“Monoclonal antibodies possess unique pharmacokinetic properties that permit flexible dosing,” the authors said. “Increased use and high costs of these medications have led to the development of cost-containing strategies.”

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