Evidências, Campinas, Brazil.
Value Health. 2011 Jul-Aug;14(5 Suppl 1):S82-4. doi: 10.1016/j.jval.2011.05.013.
Single-size vials of drugs may be a source of waste and increase in treatment costs. Bortezomib, indicated for multiple myeloma (MM) treatment, is available in 3.5-mg vials, a quantity higher than the average dose commonly prescribed. This analysis aimed to demonstrate, through real-world data, which would be the optimal vial presentation for bortezomib in Brazil and quantify the reduction in medication waste related to this option.
From November 2007 to October 2009 all patients with MM treated with bortezomib were identified via the Evidências database. Analysis of prescribed, dispensed, and wasted doses, their costs and projections of the ideal vial size were performed.
Thirty-five patients (mean body surface area of 1.73 m(2)) received 509 infusions in 131 cycles of treatment (average of 3.77 cycles per patient). The average dose prescribed was 2.1 mg per infusion (95% confidence interval [CI] 1.97-2.26) with average waste of 39.5% of the vial content (95% CI 35.35-43.76). The mean waste per patient per day was 1.38 mg (95% CI 1.24-1.52). If a 3-mg vial were available, the average drug waste per patient per day would be 0.88 mg (95% CI 0.74-1.03) or 36.2% less. With a 2.5-mg vial the waste would be 1.05 mg (95% CI 0.81-1.29) or 23.9% less. If two presentations were available (2.5 mg and 0.5 mg), the waste would be 0.52 mg (95% CI 0.4-0.63) or 62.5% less. Considering the price of the different vials to be proportional to the original 3.5-mg vial, the cost would be also reduced by the same rates described above.
A simple adjustment in vial size may reduce the waste of bortezomib by 36% to 62% and can also reduce the cost of treatment.
单剂量小瓶的药物可能是造成浪费和增加治疗成本的原因。硼替佐米用于多发性骨髓瘤（MM）的治疗，其 3.5mg 小瓶的供应量高于常用处方的平均剂量。本分析旨在通过真实世界的数据证明硼替佐米在巴西的最佳小瓶剂型，并量化与该选择相关的药物浪费减少量。
从 2007 年 11 月至 2009 年 10 月，通过 Evidências 数据库确定所有接受硼替佐米治疗的 MM 患者。对规定剂量、分发剂量和浪费剂量及其成本进行分析，并对理想小瓶大小进行预测。
35 名患者（平均体表面积为 1.73m²）接受了 509 次输液，共进行了 131 个周期的治疗（平均每个患者 3.77 个周期）。规定的平均剂量为每次输注 2.1mg（95%置信区间[CI]为 1.97-2.26），平均浪费小瓶内容物的 39.5%（95%CI 为 35.35-43.76）。每位患者每天的平均浪费量为 1.38mg（95%CI 为 1.24-1.52）。如果有 3mg 的小瓶，每位患者每天的平均药物浪费量将为 0.88mg（95%CI 为 0.74-1.03），即减少 36.2%。如果使用 2.5mg 的小瓶，浪费量将为 1.05mg（95%CI 为 0.81-1.29），即减少 23.9%。如果有两种剂型（2.5mg 和 0.5mg），浪费量将为 0.52mg（95%CI 为 0.4-0.63），即减少 62.5%。考虑到不同小瓶的价格与原始 3.5mg 小瓶成正比，成本也将按上述相同比例降低。
小瓶尺寸的简单调整可将硼替佐米的浪费减少 36%至 62%，同时也可降低治疗成本。
