NEW ORLEANS—Oncology pharmacists can save their institutions thousands of dollars annually by reducing chemotherapy waste, according to the experience of the Veterans Affairs’ North Texas Health Care System in Dallas. Sarah Gressett Ussery, PharmD, described her institution’s chemotherapy monitoring and management.
“Our findings speak to the role of the hematology/oncology pharmacist in reviewing orders for their appropriateness, and knowing which drugs are expensive,” Ussery told The Oncology Pharmacist. “Having an oncology pharmacist in charge significantly reduced waste. Before this, we were not even aware of how much was wasted.”
Ussery and colleagues documented chemotherapy waste over a 2-month period in 2005 and found that 143 chemotherapy doses were wasted, most frequently bevacizumab, docetaxel, gemcitabine, oxaliplatin, and rituximab. The total cost of waste was $90,400, which extrapolated to more than $500,000 annually. Documenting waste again, this time in a 2-month period in 2007, they identified 61 wasted doses costing $42,000, extrapolating to $250,000 annually.
The reasons for drug waste were disease progression (23%), symptomatic toxicity (18%), patient no-show (15%), wrong order or ordered too early (13%), treatment delay per patient preference (12%), dose adjustment (8%), laboratory abnormality (8%), and other reason (3%).
Concerns over this waste precipitated the hiring of a hematology/oncology pharmacist who implemented a chemotherapy management program and provided oversight. The key to this program was to delay the preparation of expensive chemotherapies.
Waste was then calculated with this program in place. Under the chemotherapy management program, waste over a 2-month period was only $15, extrapolating to $90 annually, Ussery reported.