Cancer drug waste is not chump change…

Increasing cancer care costs have the potential to derail health care systems.  We have new designer drugs, which are priced to “what the market pays”, and range from $50-150,000 a year. Often, these are taken indefinitely, transforming fatal illnesses into chronic ones, which is a good thing. In other circumstances, when the disease progresses, the lower priced chemotherapy is deemed to have failed, and the designer drug is continued in combination with the next choice of chemotherapy. There is much handwringing as to how to control the price of drugs.  Much has been discussed and written about the fairness of pricing. Across the US, community oncology practices, unable to deal with rising cost of cancer care have given up trying to deliver care and have been taken over by hospital systems. That in itself has increased cancer care costs, with reimbursement pegged to higher levels for hospital level billing.

One easy way of controlling cost is to decrease waste. We dose each patient’s treatment by his or her individual body surface area (BSA). Therefore, while the dose/ BSA is standardized, the total dose required varies by patient. Intravenous chemotherapy drugs mostly come in single use vials. Multiple vials are opened to make up the total dose. In the US, the vials come in larger sizes than in Europe. Once the vial is opened and partially used, the rest has to be thrown away. The amount of drug that needs to be thrown away every year is staggering. It’s like the penny dish at the check out counter, but the numbers are in the millions to billions.

In Europe, smaller dose vials are available, so you do not have to open a large size vial, use a small portion, and throw away the rest. This is the low hanging fruit.

1)Overspending driven by oversized single dose vials of cancer drugs BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i788 (Published 01 March 2016)

2) The Price of Drugs for Chronic Myeloid Leukemia (CML); A Reflection

of the Unsustainable Prices of Cancer Drugs: From the Perspective of

a Large Group of CML Experts: Kantarjian et al

http://www.bloodjournal.org/content/bloodjournal/early/2013/04/23/blood-2013-03-490003.full.pdf?sso-checked=true