Assessment of financial impact of anti-cancer drug wastage for pediatric hematologic malignancies as a result of inappropriate dosage forms

Abstract

Background: Considering the high-cost nature of cancer especially in developing countries and pediatrics, it is this vulnerable group and their families who will be burdened with drug wastage costs more. The main aim of this study is to evaluate the financial impact of anticancer drug wastage for pediatric hematologic malignancies because of inappropriate vial sizes. Methods: This is a descriptive-analytical study that has been performed in two university-affiliated hospitals between April2019-March2020 in Iran. First, parenteral chemotherapy drugs which prescribed for pediatrics with hematological cancers were identified. Patients’ demographics and chemotherapy regimen were recorded during saturation point sampling. In second step vial size availability, price and drug stability were recorded. To calculate costs, the weighted average price of branded and generic drugs available in the market were used. Wastage was calculated for each drug by subtraction of prescribed drug dose from the total content of consumed vial(s) during third step. Sensitivity analyses were performed for a range of (±20% and ±SD) the main influential variables. Results: Twelve drugs administered (88 times) were analyzed. The average proportion of drug wastage was 34.4% (0.0-70.0%). Drug waste expenditure was estimated to be 1,739 US$/cycle. Performing sensitivity analysis by a change of ±20% in variables, BSA, weight and drug price were the most effective factors and by a change of ±SD drug price occupied first place. Conclusion: The financial impact of anticancer drug wastage in pediatrics with hematologic malignancies in Iran was estimated in range of 19,402-278,103 US$ annually which is 0.14%-1.98% of Iran revenue from these drugs. Therefore, the prescribed dose and vial sizes mismatch can cause wastage and increase in chemotherapy indirect costs.