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.
The use of continuous-infusion in outpatient setting could be widely used in oncology and haematology care. Many times the lack of data stability about single drug or admixture of drugs, together with patient education and safety, make difficult the transition from inpatient to outpatient setting. Nowadays, this is a big challenge for hospital pharmacists, who must take into consideration the critical issues related to chemical and physical stability, besides microbiological one, in order to ensure high quality preparations and guarantee the safety and quality of care, to protect patients and their health. The aim of this article is to highlight the critical issues concerning the transition from inpatient to outpatient setting, with particular interest regarding chemotherapy protocols, which require preparation with long-term continuous-infusion.
Background and importance Oxygen is a dangerous medication because of its oxidising properties. Its use can be difficult for patients with respiratory insufficiency. Because of the impact on quality of life, oxygen dependent patients have low therapeutic adherence. This can lead to an increase in rehospitalisations and comorbidities. We have proposed educational sessions about the proper use of oxygen for these patients. Aim and objectives The aim of the study was to build educational sessions and assess their impact on patient knowledge. Material and methods The course was a collaboration between pharmacists, pulmonologists, physiotherapists, nurses and an oxygen provider service. It dealt with pathophysiology, oxygen safety, different types of equipment and travelling with oxygen. The sessions took 2 hours, once a month, and involved all patients receiving oxygen therapy in the institution. A hospital pharmacist and a pharmacist from the oxygen provider service moderated the course. Surveys were given to patients during these session to characterise the population, to measure the improvement in their knowledge before/after the course and to assess their satisfaction. Results We collected data from 43 patients. Mean age was 66.1 years and the sex ratio was 1.26. A total of 67.4% of patients used liquid equipment, 74.4% for at least 1 year: 48.8% of patients were hospitalised for pulmonary causes during the last year, 60.5% of patients had never had any education about oxygen therapy and 32.6% went out without their oxygen. The progression of patients was 4.6 points out of 20 after the educational sessions. The difference was significant (p<0.01, unilateral Student's test, paired values). All patients were satisfied with the educational sessions but 20.9% said they had concentration difficulties. Conclusion and relevance Oxygen is a treatment with limited compliance due to its impact on the quality of life of patients. The use of this essential medication must be considered at risk because it requires safety information and can cause disorders if misused. The results of this study highlight the interest in educational sessions for patient care.
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