Pharmacy World and Science

, Volume 21, Issue 4, pp 177–183 | Cite as

Implementing a multiple‐isolator unit for centralized preparation of cytotoxic drugs in a cancer center pharmacy

  • Jean‐Louis Cazin
  • Patricia Gosselin


Previous attempts to conduct economic evaluation of pharmacy services are almost exclusively from the US and the UK. Studies from the US concentrate largely on the drug cost savings realised by pharmacists. Few detail the costs of service provision and even fewer give an estimate of service benefits other than decreased drug expenditure. UK evaluation to date focuses on quantifying pharmacists' interventions, but there is no clear indication of the quality or the impact of these. This article proposes a model for economic evaluation and discusses the factors which make evaluation results useful to decision makers. The costs and outcomes, that need to be considered for economic evaluation, are discussed and the example of a pharmacist led anticoagulation clinic is used. The nature of modern health care systems demands that services are effective and, increasingly, cost‐effective. If pharmacy as a profession is to develop, decision makers must decide that pharmaceutical care delivered by pharmacists is a cost‐effective use of health care resources. Politics, education and cost pressures will mean that decision makers are likely to put more weight on the results of economic evaluation in future. If pharmacists do not start to provide good quality data about the costs and outcomes of pharmacy services then other evaluators will.

Cancer Chemotherapy Cytotoxics Isolator Pharmacy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Simon JL, Segouin C, Bertrand D, Hospital accreditation in France. Am J Health-Syst Pharm. 1998;55:173-5.PubMedGoogle Scholar
  2. 2.
    Galassi A, Molloy Hubbard S, Alexander HR et al. Chemotherapy administration: practical guidelines. In: Cancer chemotherapy and biotherapy; principles and practice. 2nd ed. Chabner BA, Longo DL, eds. Philadelphia New York: Lippincott-Raven; 1996:529-51.Google Scholar
  3. 3.
    Tilleul P, Prugnaud JL, Ponsar P. Dispensation des médicaments anticancéreux 1. Etude économique d'un système décentralisé. J Pharm Clin. 1987;6:211-24.Google Scholar
  4. 4.
    Favier M, Fliche E, Bressolle F. Economic benefit of a centralized reconstitution unit of cytotoxic drugs in isolator. J Oncol Pharm Practice. 1996;2:182-5.Google Scholar
  5. 5.
    Husson C, Harnycheff F, Becker A. Centralisation des préparations de médicaments anticancéreux injectables: mise en place et bilan dans le service pharmaceutique d'un hôpital parisien. J Pharm Clin. 1989;8:153-60.Google Scholar
  6. 6.
    Augry F, Iltis A, Letellier D et al. Evaluation de l'économie réalisée au sein d'une unité centralisée de fabrication des médicaments cytotoxiques destinés à la voie parentérale. J Pharm Clin. 1996;15:12-4.Google Scholar
  7. 7.
    Kinoo J, Becker A. Incidence économique des préparations de cytostatiques. Pharm Hosp Fr. 1993;103:5-14.Google Scholar
  8. 8.
    Pinguet F, Canal P, Favre G et al. Expérience de préparation centralisée des anticancéreux: conséquences économiques. J Pharm Clin. 1989;9:55-60.Google Scholar
  9. 9.
    Lunik MC, Peters BG, Wilson AL. Quality-improvement processes in an oncology pharmacy service. Am J Health-Syst Pharm. 1996;53:757-9.PubMedGoogle Scholar
  10. 10.
    Power LA, Anderson RW, Cortopassi R et al. Update on safe handling of hazardous drugs: the advice of experts. Am J Hosp Pharm. 1990;47:1050-60.PubMedGoogle Scholar
  11. 11.
    Society of Hospital Pharmacists of Australia. Practice Standards and definitions. Soc Hosp Pharm Austr. Melbourne: SHPA; 1996.Google Scholar
  12. 12.
    Davis KS, Goulding NM. Setting up a cytotoxic reconstitution service. In: The cytotoxics handbook. 2nd ed. Allwood MC, Wright P, eds. Oxford: Radcliffe Medical Press; 1993:1-7.Google Scholar
  13. 13.
    Goulding NM, Lee MG, Moore AC. Facilities. In: The cytotoxic handbook. 2nd ed. Allwood MC, Wright P, eds. Oxford: Radcliffe Medical Press;1993:9-24.Google Scholar
  14. 14.
    Allwood MC, Cass Y, Goss IJ et al. Health and safety aspects of cytotoxic services. In: The cytotoxic handbook. 2nd ed. Allwood MC, Wright P, eds. Oxford: Radcliffe Medical Press;1993:47-65.Google Scholar
  15. 15.
    Larroutourou P, Tangourdeau MC, Taggiasco N et al. Isotechnie en pharmacie hospitalière: application à la reconstitution centralisée des cytostatiques (1ère partie). Pharm Hosp.1989;98:9-15.Google Scholar
  16. 16.
    Larroutourou P, Tangourdeau MC, Taggiasco N et al. Isotechnie en pharmacie hospitalière: application à la reconstitution centralisée des cytostatiques (2 ème partie). Pharm Hosp. 1989;99:7-18.Google Scholar
  17. 17.
    Philip V, Saux MC. Bilan d'une année d'expérience d'une unité de reconstitution des médicaments anticancéreux au CHU de Bordeaux. Techn Hosp. 1992;565:47-56.Google Scholar
  18. 18.
    Roos I, Makela T. Human resource issues in cytotoxic drug dispensing. J Oncol Pharm Practice; 3:200-18.Google Scholar
  19. 19.
    Favier M, Hansel S, Bressolle F. Preparing cytotoxic agents in an isolator. Am J Health-Syst Pharm. 1993;50:2335-9.Google Scholar
  20. 20.
    Prugnaud JL, Tilleul P. Dispensation des médicaments anticancéreux 2. Etude économique et technique comparative de deux systèmes centralisés. J Pharm Clin. 1987;6:225-36.Google Scholar
  21. 21.
    Demange C, Aglat M. Préparation centralisée des cytostatiques. Expérience d'un centre hospitalier général. Pharm Hosp Fr. 1990;94:1363-75.Google Scholar
  22. 22.
    Buttars KA, Goss IJ et al. Documentation. In: The cytotoxic handbook. 2nd ed. Allwood MC, Wright P, eds. Oxford: Radcliffe Medical Press;1993:67-71.Google Scholar
  23. 23.
    Wourms P, May I. Maintenance d'un isolateur en Pharmacie hospitalière. Lyon Pharm. 1995;45:261-6.Google Scholar
  24. 24.
    Ignoffo RJ. Preventing chemotherapy errors. Am J Health-Syst Pharm. 1996;53:733.PubMedGoogle Scholar
  25. 25.
    Cohen MR, Anderson RW, Attilio RM et al. Preventing medication errors in cancer chemotherapy. Am J Health-Syst Pharm. 1996;53:737-46.PubMedGoogle Scholar
  26. 26.
    Jenkins D, Cairns C, Barber N. The quality of written inpatient prescriptions. Int J Pharm Pract. 1993;2:176-9.Google Scholar
  27. 27.
    Kohler DR, Montello MJ, Green L et al. Standardizing the expression and nomenclature of cancer treatment regimens. Am J Hosp Pharm. 1998;55:137-44.Google Scholar
  28. 28.
    Holmes BC. Administration of cancer chemotherapy agents. In: Cancer chemotherapy handbook. 2nd ed. Dorr RT, Von Hoff DD, eds. Norwalk: Appleton and Lange; 1994:57-94.Google Scholar
  29. 29.
    Boddy AV, Calvert AH. Individualized dosing of anticancer drugs. In: Principles of antineoplastic drug development and pharmacology. Schilsky RL, Milano GA, Ratain MJ, eds. New York: Marcel Dekker; 1996:435-55.Google Scholar
  30. 30.
    Trissel LA. Handbook on injectable drugs. 9th ed. Bethesda: American Society of Health System Pharmacists;1996.Google Scholar
  31. 31.
    Husson MC, Becker A. Médicaments anticancéreux; de la préparation à l'administration. Optimisation. Editions Médicales Internationales; 1995.Google Scholar
  32. 32.
    Vigneron J, Cholvy-Laurelli F, Noirez V et al. Préparation et administration des traitements anticancéreux. 2nd ed. Lyon; Aguettant; 1996.Google Scholar
  33. 33.
    Barber N. What constitutes good prescribing? Br Med J. 1995;310:923-5.Google Scholar
  34. 34.
    Lunik MC, Wilson AL, Hill JJ et al. Pharmacy information systems: an outlook future goals. In: Pharmacy information systems: justifying, evaluating and implementing a system. Bethesda: American Society of Hospital Pharmacists; 1993:91-102.Google Scholar
  35. 35.
    Kaijser GP, Underberg WJM, Beijnen JH. The risks of handling cytotoxic drugs. II Recommendations for working with cytotoxic drugs. Pharm Weckbl [Sci] 1990;12:228-35.Google Scholar
  36. 36.
    American Society of Hospital Pharmacy. ASHP technical assistance bulletin on handling cytotoxic and hazardous drugs. Am J Hosp Pharm. 1990;47:1033-49.Google Scholar
  37. 37.
    Ignoffo R, Stagg RJ. The role of the pharmacist in oncology: clinical practice and research. In: Fundamentals of cancer chemotherapy. Hellmann K, Carter SK, eds. New York: Mc Graw-Hill;1987:359-73.Google Scholar

Copyright information

© Kluwer Academic Publishers 1999

Authors and Affiliations

  • Jean‐Louis Cazin
  • Patricia Gosselin

There are no affiliations available

Personalised recommendations