Redispensing Quality-Approved Oral Anticancer Drugs Decreases Costs

Redispensing unused oral anticancer drugs (OADs) decreased costs, according to results of a study published in JAMA Oncology.

High drug costs and supply shortages are major contributors to difficulties with sustainable and affordable access to OADs.

To test whether redispensing unused OADs may feasibly decrease costs, this prospective, single-group multicenter intervention study (WHO International Clinical Trials Registry Platform Identifier: NL9208) was conducted. A total of 1071 patients who were receiving OAD treatment at 4 hospitals in the Netherlands between 2021 and 2023 were asked to return unused packaged pills. Pharmacy employees evaluated the quality of returned OADs by whether the packaging was unopened and undamaged and had adequate shelf life.

The patients were median age 70 years; 58.1% were men; 51.2% had a solid cancer; and 56.8% were receiving targeted therapies, 22.1% cytotoxic agents, 13.2% endocrine therapy, and 7.9% immunosuppressants.

The average annual cost of OADs was €41,421 (95% CI, €39,231-€43,451) per patient.

A total of 13,069 OAD packages were dispensed during the study and 16.0% of patients returned 335 unused OAD packages, or 2.6% of all OADs.

The returned packages were primarily of targeted therapies (68.0%), followed by endocrine therapy (18.0%), immunosuppressants (7.5%), and cytotoxic agents (6.6%). The OADs were returned due to disease progression (47.4%), drug switch (44.8%), discontinuation (34.0%), toxic effects (29.4%), or dose adjustments (18.0%).

After quality assurance, 228 packages were redispensed, reducing waste by 68.1%. This waste reduction equated to an annual cost savings of €576 per patient.

The findings in this study may not be generalizable for the United States, as drugs are 377% more expensive than in the Netherlands.

The study authors concluded, “This multicenter intervention study demonstrated substantial waste reduction associated with redispensing of quality-approved OADs unused by patients, which generated substantial cost savings compared with the standard practice of disposal.”

Reference

Smale EM, van den Bemt BJF, Heerdink ER, Desar IME, Egberts TCG, Bekker CL; ROAD Study Group. Cost savings and waste reduction through redispensing unused oral anticancer drugs: the ROAD Study. JAMA Oncol. Published online November 16, 2023. doi:10.1001/jamaoncol.2023.4865