Economic impact of waste in Prescribing, Dispensing, and Medication consumption in the United States

Almanie, S.A.; Holdford, DA

doi:10.1016/j.jval.2015.03.476

Cited by 4 publications

(4 citation statements)

References 59 publications

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“…Others [83][84][85][86] have found that costs of drug wasting can be significant, ranging from $185,000 for 543 surgical cases [83] up to $30 billion annually [87]. In an earlier study, Mankes [71], found eliminating larger vial sizes of propofol, by stocking only 20 mL size had a significant reduction in propofol waste.…”

Section: Discussionmentioning

confidence: 99%

Pharmaceutical Dispensing and Wasting In Health Care Facilities, Amounts, Costs and Evaluation of Potential Ecologic Effects

Mankes¹,

Silver²

2017

SOJPPS

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Drug waste from hospitals contributes to environmental contamination. Patient excreta, bathing or discarding of excess drugs are some sources of drug waste. We report on the wasting of 84 drugs of 14 therapeutic classes in two hospitals in Albany, NY. We consider drug metabolism, excretion, disposal and ecotoxicity in strategies for reducing drug waste, costs and potential environmental damage.Medication (12,345) and waste collection (199) records for: drugs dispensed, returned and wasted were examined. Of 2,700 drugs available, 84 drugs from 14 classes, weighing 56 kg were dispensed to patients, and 2.3 kg were wasted. Twelve drugs accounted for 80 percent of the drug waste and cost $111,000. Of the top wasted and dispensed drugs, all but ibuprofen are persistant and none were bioaccumulative. Ibuprofen, ipratropium ondansetron and oxymetazoline are "very highly toxic" or "highly toxic". Environmental Risk Ratio (PEC/PNEC) for the 20 top drugs were"Insignificant" or "Cannot Be Excluded".Acetazolamide is the most toxic to fish. Dexamethasone has the greatest chronic toxicity to Ceriodaphnia. Ibuprofen is predicted to be very highly toxic (acute and chronic) to zebra mussel, crab and fish. Neostigmine is the most acutely toxic (LC50<1 mg/L) to Daphnia. Ondansetron is the most acutely toxic to green algae. All but 2 of the drugs were 5 to 100% excreted. Fourteen were metabolised. Active metabolites were formed from 2 drugs. Nicardipine, ondansetron and prednisone formed drug conjugates which were excreted. Incineration was the manufacturer's recommended disposal method.We recommend excess drugs be returned to the hospital pharmacy for disposal by incineration. Drug use and disposal should be monitored by an expert committee according to recognized guidelines of pharmaceutical management. Knowledge of the adverse impacts from the release of highly toxic drugs into the environment must influence drug selection and disposal.Key words: Waste; Ecotoxicity; Wastewater; Abbreviations AMCH = Academic Medical Center Hospital; ASTER = Assessment Tools for the Evaluation of Risk. United States Environmental Protection Agency https://archive.epa.gov/med/med_archive_03/web/html/ aster.html Last accessed 6/4/17; B = Bioaccumulation is the general term describing a process by which chemicals are taken up by an organism either directly from exposure to a contaminated medium or by consumption of food containing the chemical; EC50 = Effective Concentration producing an adverse effect in 50% of a test species; EbC50 or ErC50 = EC50 in terms of reduction of growth rate; EyC50 = EC50 in terms of change in biomass yield; Ecosar = Ecologic Structure Activity Relationships is a computerized predictive system that estimates aquatic toxicity. The program estimates a chemical's acute (short-term) toxicity and chronic (long-term or delayed) toxicity to aquatic organisms such as fish, invertebrates, and plants by using computerized Structure Activity Relationships (SARs). https://www.epa.gov/tsca-screening-tools/ ecological-structure-...

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Section: Discussionmentioning

confidence: 99%

Pharmaceutical Dispensing and Wasting In Health Care Facilities, Amounts, Costs and Evaluation of Potential Ecologic Effects

Mankes¹,

Silver²

2017

SOJPPS

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“…In terms of cost, one unclaimed prescription is estimated to be $11.50 [8]. In a different study, the estimated cost is $37 per unclaimed prescription [9]. Studies with different demographic groups show different results.…”

Section: Introductionmentioning

confidence: 94%

Prevalence of Uncollected Medicines at Two Health Centers in Brunei

Kifli

Ismail

Chua

2021

Asian J Pharm Clin Res

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Objective: This study was designed to achieve a better knowledge of uncollected medicines at two health centers in Brunei. Methods: Patients with prescriptions prepared at two community pharmacies but did not collect them within 1 week from March 2020 to April 2020 were included in this study. A telephone interview was conducted to discover why they did not collect their medicines. Results: A total of 43 patients completed the study, giving a rate of 0.85% uncollected prescriptions. A proportion of 24% of the uncollected medicines was cardiovascular drugs, 35% belonged to participants who forgot to collect their medicines, and 14% were uncollected due to participants being too busy. Conclusion: Further studies should be done to identify interventions that could decrease the number of uncollected medicines.

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“…The economic impact of over-prescribed and under-consumed prescription medications (PMs) is becoming an exceedingly challenging phenomenon. In 2012 alone, the total cost of unfilled, abandoned, or unused PMs in the US health care system was conservatively estimated at $14 billion, 1 while another study in 2015 estimated that the total waste of unused PMs in the United States may exceed $117 billion. 2 Coupled with a subsequent assortment of unintended secondary consequences, opioids are perhaps some of the most problematic, overprescribed PMs.…”

Section: What This Study Addsmentioning

confidence: 99%

Implementation of formal prescription guidelines reduces the economic cost of unused opioids after orthopedic surgery

Schaefer¹,

Nouraee²,

Blake³

et al. 2021

JMCP

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BACKGROUND:Prior literature has reported on the concerning emergence of opioid overprescribing, yet there remains a lack of knowledge in understanding the cost of waste of this over-prescription and underconsumption of opioids. As such, further investigating the cost of waste of opioids following orthopedic surgery is of interest to patients, providers, and payors. In one of the largest private orthopedic practices in the United States, opioid prescribing and consumption patterns were tracked prior to, and after the implementation of, formal prescription guidelines. OBJECTIVES:To (1) establish the cost of waste of unused opioids before the implementation of formal prescription guidelines and (2) examine how the cost of unused opioids may be reduced after implementation of formal internal prescription guidelines. METHODS:Two separate phases (Phase I and Phase II) were implemented at different time intervals throughout a two-year period. Implementation of prescription guidelines occurred between Phases I and II, and data from Phase I (pre-implementation) was compared to that from Phase II (postimplementation). Data collection included type, dosage, quantity of opioids prescribed and consumed after elective outpatient procedures in ambulatory surgery centers, in addition to patient interviews/surveys within two weeks after surgery to measure consumption. From these data, the cost of waste was calculated by taking the total cost of prescribed opioids (sum of each prescription × Average Wholesale Price (AWP) minus 60%) per 1,000 patients, and subtracting the total cost of consumed opioids per 1,000 patients, calculated in a similar manner. Further analysis was performed to describe differences in the cost of waste of individual opioids between each of the phases.

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Economic impact of waste in Prescribing, Dispensing, and Medication consumption in the United States

Cited by 4 publications

References 59 publications

Pharmaceutical Dispensing and Wasting In Health Care Facilities, Amounts, Costs and Evaluation of Potential Ecologic Effects

Pharmaceutical Dispensing and Wasting In Health Care Facilities, Amounts, Costs and Evaluation of Potential Ecologic Effects

Prevalence of Uncollected Medicines at Two Health Centers in Brunei

Implementation of formal prescription guidelines reduces the economic cost of unused opioids after orthopedic surgery

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