2058P - Reducing waste to improve sustainability and affordability of cancer treatment: Redispensing unused oral anticancer drugs

Background

Strategies targeting oral anticancer drug (OAD) waste are required to improve sustainability and affordability of these expensive treatments frequently remaining unused by patients. This study aims to quantify waste reduction, cost-savings and environmental impact obtained by redispensing unused OADs compared to standard practice of disposal.

Methods

A prospective, single-arm intervention study was conducted in four Dutch hospitals. Eligible patients were ≥18 years, diagnosed with cancer and prescribed an OAD. During twelve months, participants received OAD packages sealed with a time-temperature indicator. If unused, OADs were returned to the pharmacy where quality was assured by checking authenticity, shelf life and storage temperature. OADs of verified quality were redispensed to other patients. Waste reduction was expressed as the percentage returned OADs that were redispensed. Mean annual cost-savings per patient were costs of redispensed OADs minus operational expenses from a healthcare perspective. Impact on environmental indicators was assessed via a cradle-to-grave Life Cycle Assessment. Patient subgroups associated with positive cost-savings were identified with multiple logistic regression. Scenarios analyses on the effect of optimized quality assurance and patient population selection was performed.

Results

1,071 patients participated, median age 70 years (IQR: 62–75) and 41.9% female. 224 OAD packages (1.7%) of 128 patients (12.0%) were redispensed (2.4% of total drug costs), reducing waste by 68.1% and providing mean annual cost-savings of €576 per patient (95% CI: 444–709). Optimizing quality assurance and targeting patient subgroups (< 24 months OAD use/using targeted therapies) could increase mean annual cost-savings up to €1,348 (1,039 – 1,697) per patient. Waste reduction was associated with mean annual environmental benefits of >1 kg CO₂ per patient, but only with an optimized quality assurance procedure a net beneficial impact on environmental indicators was achieved.

Conclusions

Redispensing unused OADs reduces waste substantially, generates cost-savings and can benefit environmental impact, improving sustainability and affordability of cancer treatment.

Clinical trial identification

WHO International Clinical Trials Registry Platform (ICTRP) Identifier: NL9208.

Editorial acknowledgement

Legal entity responsible for the study

ROAD-study group.

Funding

Netherlands Organisation for Health Research and Development ZonMw (grant 848018008).

Disclosure

All authors have declared no conflicts of interest.