Rounding Down Chemotherapeutic Agents to the Nearest Vial Size as a Cost Containment Measure
Keywords:
Chemotherapy wastage, Dose rounding, Cost-savingAbstract
Background: High cancer treatment costs significantly affect health care expenditures. Drug
waste reduction of costly drugs can reduce the treatment cost.
Methods: A retrospective study conducted at King Abdulaziz Medical City (KAMC), Riyadh,
Saudi Arabia. Adult patients above age of 14 years old who received chemotherapy between
March 1st to March 31st, 2015 were included. Maximum dose rounding allowed was up to 10%
for palliative intent and 5% for curative intent. Patients demographics, diagnosis, treatment
intent (cure or palliation), ordered dose, rounded dose, vial size, number of vials that could be
saved and expected cost saved per month were calculated and recorded.
Results: A total of 305 patients received 973 doses of intravenous chemotherapy drugs during
the study period. Orders of 352 doses could be rounded to the nearest vial size with a 10% dose
deviation for palliative intent and 5% for curative intent. The projected savings for 1 month was
calculated to be Saudi Riyals (SR) 14,720.95 for 5% rounding limit and SR 53,157.50 for 10%
rounding which will account to an estimate of SR 814,514.40 of drug cost savings per year.
Anti-cancer drugs with the most drug wastage due to non-rounding to the nearest vial size were
trastuzumab, cyclophosphamide, etoposide, methotrexate, fluorouracil, paclitaxel, oxaliplatin,
doxorubicin, bortezomib, and cytarabine consecutively. The highest costs savings when rounding
the doses to the nearest vial size up to 5% for curative intent was associated with rituximab,
followed by fludarabine and paclitaxel. Bevacizumab, cetuximab, and carfilzomib have
resulted in the most cost savings when the rounding limit was set to 10% for palliative intent.
Conclusion: Dose rounding of the ordered dose to an amount within 5% for curative intent and
10% for palliative intent to the nearest vial size has resulted in a valuable cost savings through
reduction of drug wastage without any expected compromise in efficacy.
