Cost reduction as a result of bortezomib vial sharing in the University Hospital Center ‘Mother Theresa’ Tirana

Rustemi, Florjana; Malaj, Ledjan; Hoti, Ela; Balla, Enida

doi:10.1136/ejhpharm-2018-001676

Cited by 4 publications

(6 citation statements)

References 3 publications

(3 reference statements)

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“…21 Pilot studies have shown that vial sharing and batching programs for bortezomib doses reduce wasted medication and pharmaceutical spending by 24%-26%. 22,23 Average weights for American adults are 90 kg for males and 77 kg for females. 24 Pembrolizumab conversion to a 200 mg fixed dose corresponds to an average weight of 100 kg, far exceeding population averages.…”

Section: Discussionmentioning

confidence: 99%

Economics of alternative dosing strategies for pembrolizumab and nivolumab at a single academic cancer center

et al. 2020

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Background The FDA initially approved pembrolizumab and nivolumab for doses based on patient weight, but subsequently amended approval to fixed doses. We estimated savings from novel dosing strategies based on real‐world patient data from a single cancer center. Methods We analyzed all outpatient doses of pembrolizumab and nivolumab administered at three infusion centers affiliated with our academic hospital between July 1, 2018 and Oct 31, 2018. We estimated savings from several dosing strategies with and without vial sharing between patients. Results A total of 1029 doses of pembrolizumab or nivolumab were administered for multiple cancer types. For 77% of doses, the weight‐based dose was less than the fixed dose. “Dose‐minimization” (DM), defined as the lesser of weight‐based and fixed dose decreased nivolumab spending by 9% without affecting pembrolizumab spending. DM plus vial sharing decreased pembrolizumab spending by 19% without affecting nivolumab. The differences in savings were due to availability of multiple vial sizes for nivolumab but not pembrolizumab. DM plus vial sharing for both drugs would have saved $1.5 million USD over the 4‐month study period. Conclusion New dosing strategies for pembrolizumab and nivolumab can generate large savings without anticipated decrease in efficacy. Barriers include FDA dosing labels, hospital policies against vial sharing, and inaccessibility of smaller vial sizes, which are currently available in other worldwide markets.

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Section: Discussionmentioning

confidence: 99%

Economics of alternative dosing strategies for pembrolizumab and nivolumab at a single academic cancer center

et al. 2020

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“…Nonetheless, the study has demonstrated substantial cost savings due to vial-sharing, which supports other studies that encourage the use of vial-sharing to reduce chemotherapy wastage. 9,12,25…”

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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“…Choosing optimal vial sizes for chemotherapy drugs is a simple strategy to reduce wastage and minimize chemotherapy costs 30‐33 . Carfilzomib was initially only available in Canada as a 60 mg vial.…”

Section: Discussionmentioning

confidence: 99%

A descriptive cost‐analysis of MYX.1/MCRN003, a phase 2 clinical trial evaluating high‐dose weekly carfilzomib, cyclophosphamide, and dexamethasone in relapsed and refractory multiple myeloma

Monteith

Venner

Cheung

et al. 2021

European J of Haematology

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Background The prevalence of multiple myeloma is increasing and there is a need to evaluate escalating therapy costs (Canadian Cancer Statistics A, 2020). The MYX.1 phase II trial showed that high‐dose weekly carfilzomib, cyclophosphamide, and dexamethasone (wKCD) is efficacious in relapsed and refractory disease. We conducted a descriptive cost analysis, from the perspective of the Canadian public healthcare system, using trial data. Methods The primary outcome was the mean total cost per patient. Resource utilization data were collected from all 75 trial patients over a trial time horizon. Costs are presented in Canadian dollars (2020). Results The cost of treatment was calculated from the time of patient (pt) enrollment until the second data lock. The mean total cost was $203 336.08/pt (range $17 891.27‐$505 583.55) Canadian dollars (CAD, where 1 CAD = 0.67 Euro (EUR)) and $14 081.45/pt per cycle. The median number of cycles was 15. The predominant cost driver was the cost of chemotherapy accounting for an average of $179 332.78/pt or $12 419.17/pt per cycle. Carfilzomib acquisition accounted for the majority of chemotherapy costs – $162 471.65/pt or $11 251.50/pt per cycle. Fifty‐six percent (56%) of patients had at least one hospitalization during the trial period with an average cost of $12 657.86 per hospitalization. Three patients developed thrombotic microangiopathy (TMA) with an average cost of $18 863.32/pt including the cost of hospitalizations and therapeutic plasma exchange. Conclusions High‐dose wKCD is an active triplet regimen for relapsed and refractory multiple myeloma (RRMM) associated with reduced total cost compared with twice‐weekly carfilzomib‐based regimens.

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Cost reduction as a result of bortezomib vial sharing in the University Hospital Center ‘Mother Theresa’ Tirana

Cited by 4 publications

References 3 publications

Economics of alternative dosing strategies for pembrolizumab and nivolumab at a single academic cancer center

Economics of alternative dosing strategies for pembrolizumab and nivolumab at a single academic cancer center

Quantifying chemotherapy wastage in an ambulatory cancer centre in Singapore

A descriptive cost‐analysis of MYX.1/MCRN003, a phase 2 clinical trial evaluating high‐dose weekly carfilzomib, cyclophosphamide, and dexamethasone in relapsed and refractory multiple myeloma

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