Skip to main content
SpringerLink
Log in

An economic evaluation of vial sharing of expensive drugs in automated compounding

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Manual compounding of expensive cytotoxic drugs often leads to drug wastage, due to residual product in vials not being used. Aim To determine the cost savings that can be achieved by implementing an automated compounding process with a vial sharing strategy, instead of manually compounding drugs. Method The drug wastage during automated compounding was compared with that of three simulation scenarios using manual compounding, in a general teaching hospital. All automatically compounded preparations of rituximab, pemetrexed, bevacizumab, and trastuzumab from September 2019 and up until February 2020 were included. A vial sharing strategy was implemented during the automated compounding process (scenario 1). In this scenario, all residual drugs could be reused for up to seven days. Two of the simulation scenarios for manual compounding were executed using a batch compounding strategy, for an entire working day (scenario 2), and twice a day (scenario 3). The third manual compounding simulation was executed without making use of a batch compounding strategy (scenario 4). Results There was no drug wastage during automated compounding with vial sharing (scenario 1). The cost of drug wastage for 1001 preparations, over a period of six months for rituximab, pemetrexed, bevacizumab, and trastuzumab combined, were € 34,133 for scenario 2, € 46,688 for scenario 3, and € 88,255 for scenario 4. The estimated total cost savings between 2017, when the compounding robot was commissioned, and 2021, was more than € 280,000. Conclusion Vial sharing of expensive drugs during automated compounding can prevent drug wastage, resulting in an economic and environmental advantage as opposed to manual compounding.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Elkin EB, Bach PB. Cancer’s next frontier: addressing high and increasing costs. JAMA. 2010;303:1086–7.

    Article  Google Scholar 

  2. Caplan AL. Will evidence ever be sufficient to resolve the challenge of cost containment? J Clin Oncol. 2011;29:1946–8.

    Article  Google Scholar 

  3. Eudralex GMP, Annex 1. Manufacture of sterile medicinal products. 2008. https://ec.europa.eu/health/documents/eudralex/vol-4. Accessed 5 Jul 2021.

  4. Fasola G, Aprile G, Marini L, et al. Drug waste minimization as an effective strategy of cost-containment in oncology. BMC Health Serv Res. 2014;14:57.

    Article  Google Scholar 

  5. De Graaf H, Haisma JA. Verworpen vials. Med Contact (Bussum). 2006;61:748–50.

    Google Scholar 

  6. Au YS, Knoester P. Spillage dure medicatie kan drastisch minder. Maatregelen maken forse besparingen mogelijk. Pharm Weekbl. 2011.

  7. Winger BJ, Clements EA, DeYoung JL, et al. Cost savings from dose rounding of biologic anticancer agents in adults. J Oncol Pharm Pract. 2011;17:246–51.

    Article  Google Scholar 

  8. Patel S, Le A. Rounding rituximab dose to nearest vial size. J Oncol Pharm Pract. 2013;19:218–21.

    Article  CAS  Google Scholar 

  9. Francis SM, Heyliger A, Miyares MA, et al. Potential cost savings associated with dose rounding antineoplastic monoclonal agents. J Oncol Pharm Pract. 2015;21:280–4.

    Article  Google Scholar 

  10. Lindsey S, Parsons LB, Figg LR, et al. Evaluation of the dosing strategies of biologic agents and the theoretical impact of dose rounding. J Oncol Pharm Pract. 2018;24:47–55.

    Article  Google Scholar 

  11. Afanasjeva J, Gruenberg K. Pharmacists as environmental stewards: Strategies for minimizing and managing drug waste. Sustain Chem Pharm. 2019;13:100164.

    Article  Google Scholar 

  12. Smale EM, Egberts TCG, Heerdink ER, et al. Waste-minimising measures to achieve sustainable supply and use of medication. Sustain Chem Pharm. 2021;20:100400.

    Article  CAS  Google Scholar 

  13. Fasola G, Aita M, Marini L, et al. Drug waste minimisation and cost-containment in Medical Oncology: two-year results of a feasibility study. BMC Health Serv Res. 2008;8:70.

    Article  Google Scholar 

  14. Batson S, Mitchell SA, Lau D, et al. Automated compounding technology and workflow solutions for the preparation of chemotherapy: a systematic review. Eur J Hosp Pharm. 2020;27:330–6.

    Article  Google Scholar 

  15. Werumeus Buning A, Geersing TH, Crul M. The assessment of environmental and external cross-contamination in preparing ready-to-administer cytotoxic drugs: a comparison between a robotic system and conventional manual production. Int J Pharm Pract. 2020;28:66–74.

    Article  Google Scholar 

  16. Geersing TH, Klous MG, Franssen EJF, et al. Robotic compounding versus manual compounding of chemotherapy: comparing dosing accuracy and precision. Eur J Pharm Sci. 2020;155:105536.

    Article  CAS  Google Scholar 

  17. Masini C, Nanni O, Antaridi S, et al. Automated preparation of chemotherapy: quality improvement and economic sustainability. Am J Health Syst Pharm. 2014;71:579–85.

    Article  Google Scholar 

  18. Geersing TH, Franssen EJF, Pilesi F, et al. Microbiological performance of a robotic system for aseptic compounding of cytostatic drugs. Eur J Pharm Sci. 2019;130:181–5.

    Article  CAS  Google Scholar 

  19. Besheer A, Mahler HC, Matter-Schwald A, et al. Evaluation of different quality-relevant aspects of closed system transfer devices (CSTDs). Pharm Res. 2020;37:81.

    Article  CAS  Google Scholar 

  20. Sreedhara A, Zamiri C, Goswami S, et al. Challenges of using closed system transfer devices with biological drug products: an industry perspective. J Pharm Sci. 2020;109:22–9.

    Article  CAS  Google Scholar 

  21. Respaud R, Tournamille JF, Saintenoy G, et al. Computer-assisted management of unconsumed drugs as a cost-containment strategy in oncology. Int J Clin Pharm. 2014;36:892–5.

    Article  Google Scholar 

  22. Edwards MS, Solimando DA, Grollman FR, et al. Cost savings realized by use of the PhaSeal(®) closed-system transfer device for preparation of antineoplastic agents. J Oncol Pharm Pract. 2013;19:338–47.

    Article  CAS  Google Scholar 

  23. Siderov J. Utility of PhaSeal, a closed-system drug transfer device, in facilitating vial sharing to reduce waste and assist in medication cost savings. J Pharm Pract Res. 2019;49:421–5.

    Article  Google Scholar 

  24. Hess LM, Cui ZL, Li XI, et al. Drug wastage and costs to the healthcare system in the care of patients with non-small cell lung cancer in the United States. J Med Econ. 2018;21:755–61.

    Article  Google Scholar 

  25. Liran O, Prus J, Gordon N, et al. A real-world analysis of cancer drug wastage due to oversized vials. J Am Pharm Assoc. 2018;58:643–6.

    Article  Google Scholar 

  26. Gopisankar MG, Wahlang J, Jagtap V, et al. Cancer chemotherapy drug wastage in a tertiary care hospital in India-A 3-month prospective and 1-year retrospective study. Br J Clin Pharmacol. 2019;85:2428–35.

    Article  CAS  Google Scholar 

  27. Smith R. A 2-year retrospective review of vial sharing options for the compounding of cytotoxics. Eur J Hosp Pharm. 2015;22:161–4.

    Article  Google Scholar 

  28. Goldstein DA, Clark J, Tu Y, et al. A global comparison of the cost of patented cancer drugs in relation to global differences in wealth. Oncotarget. 2017;8:71548–55.

    Article  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge Prof. Dr. Catherijne Knibbe for reading the manuscript critically. We also remember and thank the late prof. Dr. Wim Jiskoot for his feedback while writing the manuscript.

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Author notes

  1. Simone D. Baan and Tjerk H. Geersing contributed equally to this work as first authors.

Authors and Affiliations

  1. Department of Clinical Pharmacy, OLVG Hospital, Amsterdam, The Netherlands

    Simone D. Baan, Tjerk H. Geersing, Eric J. F. Franssen & Marjolein G. Klous

  2. Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Center, Amsterdam, The Netherlands

    Mirjam Crul

Authors
  1. Simone D. Baan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tjerk H. Geersing
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mirjam Crul
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric J. F. Franssen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marjolein G. Klous
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tjerk H. Geersing.

Ethics declarations

Conflicts of interest

The authors have no conflicts of interest to declare.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baan, S.D., Geersing, T.H., Crul, M. et al. An economic evaluation of vial sharing of expensive drugs in automated compounding. Int J Clin Pharm 44, 673–679 (2022). https://doi.org/10.1007/s11096-022-01388-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-022-01388-6

Keywords

Search

Navigation