6557 Background: To control costs while maintaining or improving the quality of patient care is challenging for physicians and health care managers. The problem has become critical in oncology, due to the increasing number of cancer cases and the recent availability of new drugs, with a dramatic rise in health care expenditure. Here we report the experience of our Medical Oncology Department, where centralization of chemotherapy (CT) manufacturing and development of a computerized physician order-entry (CPOE) system allowed an effective planning of CT services with a substantial waste minimization and a significant cost saving. Methods: Starting January 2005 we collected data about drug demand, real consuming and resulting wastes and quantified the economic value of drug leftovers. Finally, based on a web literature search and a survey among other Cancer Services, an internal protocol for waste limitation was developed. Main adopted measures were: 1) a rational, per pathology distribution of CT sessions over the week, allowing waste recovery while respecting drug stability; 2) the use of multi-dose vials, that maintain microbial and chemical stability for up to 28 days; 3) a reasonable dose rounding, to fit with available vial sizes/leftovers; 4) the selection of the most convenient vial size when more options are available. Results: The baseline analysis focused on 29 drugs over a 1-year period. Considering their price per milligram and the amount of wastes, we found that 74% of the expense was attributable to six compounds only (cetuximab, docetaxel, gemcitabine, oxaliplatin, pemetrexed and trastuzumab) and that the economic loss due to their waste equaled 4.5% of the annual drug expenditure. Following the application of the above listed measures, the monetary loss due to unused drugs showed an impressive 45% reduction throughout 2006. Conclusions: Our experience may represent an accessible model in addressing the issue of cost rising in oncology. A critical evaluation and planning of CT daily workload, provided by CPOE, and a multidisciplinary effort to pursue specific waste reduction strategies produce a relevant cost saving. No significant financial relationships to disclose.