Responding to drug shortages and rising costs: IV chemotherapy drug use optimization achieved by closed safety devices in hospital pharmacies

Abstract

The aim of this article was to assess whether the use of closed system drug transfer devices (CSTDs) can successfully extend the shelf-life of intravenous (IV) cytotoxic drugs and thus contribute to financial savings to the pharmacy budget. In two study centres, two 6-month studies of the same design were conducted simultaneously. Three months of withdrawal of IV cytotoxic drugs from vials using conventional needle/syringe methods was compared with 3 months of using a CSTD (Tevadaptor®). During the study, the maximal withdrawable drug quantity from vials and loss due to discarding residuals, mostly in connection with sterility concerns, were measured according to the applied techniques. As the applied CSTD system eliminates microbiological risks, drug shelf-life was extended with CSTD use in the second period. The costs of drugs using conventional dispensing versus CSTD use were also compared. The amount of drug remaining in vials did not significantly differ between needle/syringe and CSTD use. Amount of drugs saved by CSTD use (through the extension of their shelf-life) was significant in all comparisons. For a set of 9 and 20 generic IV chemotherapy drugs, annual drug cost savings of €54,117 (Centre 1) and €16,901 (Centre 2) may be achieved, representing 3.9 and 3.4 % of the pharmacy budgets of the respective centres. When expensive IV biological drugs are considered, budget savings of up to 18.6 % may be achieved with CSTD use. Microbiological stability is the largest obstacle in efficient IV drug utilization. It usually means a 24-h expiry after preparation, although the physicochemical stability of the drug exceeds this period. The use of a CSTD, combined with a standard aseptic environment, provides sterility for the admixture during the preparation process. Taking advantage of the extended drug shelf-lives of drugs provided by the use of a CSTD (Tevadaptor® in this study), a significant amount of drug can be saved, resulting in financial benefits for the pharmacy budget.