S14 - The drug day an effective strategy for the containment of pharmaceutical costs

Abstract

Background: The Centralized Unit for Handling Antineoplastic of National Cancer Institute “G. Pascale” of Naples planned a strategy for the use of high cost cancer drug, like Yervoy®. In order to reduce the therapy cost we decide to dedicate for Yervoy® a drug day, i.e. to concentrate preparation of therapeutic protocols in one specific days per week, to optimize the use of drug vials with reduction of waste and/or optimal use of the residues. The aim of this work was to report the analysis of two years (2014-2015) of drug consumption and cost. Materials and methods: The experimental phase was organized in accord with Yervoy® prescribed physicians. The number of patients treated, consumption and cost data relating to years 2014 and 2015 were collected from the hospital database. The number of therapy cycles and the individual patient's treatment line were detected by the AIFA database, since Yervoy® is subject to central monitoring. In primis, it was performed an assessment of the total consumption and cost per year and then a comparison exercise was made between the number of drug vials really used and those that should be used without the drug day and, the comparison between the real cost incurred and the hypothetical cost out of drug day. Results: In 2014 and 2015 the pharmacy staff set 466 preparation, for 149 patients, and 606 preparation, for 198 patients, respectively of Yervoy®. It was dedicated one day a week for treatment as drug day for Yervoy® treatment with a range of 8-12 preparations per day. Comparing the used drug in drug day to a hypothetical daily preparation, in 2014 we saved 16,850mg (approximately 84 vials of 200mg) with an economy of €995,295.8. Similarly in 2015 we saved 18,245mg (approximately 91 vials of 200mg) with an economy of €1,077,695.66. Noteworthy, the overfill of injecting drug vials, corresponding to about 10-12 mg over the declared amount of drug, as prescribed by F.U. XII Edition (2.9.17) and, similarly, by FDA guidelines on the filling volume in excess of vials, allowed us to rescue 5,626mg in 2014 and 7,089mg in 2015, with an economy of €332,316.57 and €418,733.05 respectively. Conclusions: Drug day allows to reduce at minimum drug waste residues and, furthermore, to use overfill of the samples, which should became waste (Yervoy® stability is 24 h). Programming cancer therapies in drug day resulted a very effective tool for the containment of pharmaceutical costs.