Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Hematology and Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Cancer. 2017 Sep 15;123(18):3583-3590. doi: 10.1002/cncr.30807. Epub 2017 Jun 22.
The objective of this study was to determine the impact of modeling cancer drug wastage in economic evaluations because wastage can result from single-dose vials on account of body surface area- or weight-based dosing.
Intravenous chemotherapy drugs were identified from the pan-Canadian Oncology Drug Review (pCODR) program as of January 2015. Economic evaluations performed by drug manufacturers and pCODR were reviewed. Cost-effectiveness analyses and budget impact analyses were conducted for no-wastage and maximum-wastage scenarios (ie, the entire unused portion of the vial was discarded at each infusion). Sensitivity analyses were performed for a range of body surface areas and weights.
Twelve drugs used for 17 indications were analyzed. Wastage was reported (ie, assumptions were explicit) in 71% of the models and was incorporated into 53% by manufacturers; this resulted in a mean incremental cost-effectiveness ratio increase of 6.1% (range, 1.3%-14.6%). pCODR reported and incorporated wastage for 59% of the models, and this resulted in a mean incremental cost-effectiveness ratio increase of 15.0% (range, 2.6%-48.2%). In the maximum-wastage scenario, there was a mean increase in the incremental cost-effectiveness ratio of 24.0% (range, 0.0%-97.2%), a mean increase in the 3-year total incremental budget costs of 26.0% (range, 0.0%-83.1%), and an increase in the 3-year total incremental drug budget cost of approximately CaD $102 million nationally. Changing the mean body surface area or body weight caused 45% of the drugs to have a change in the vial size and/or quantity, and this resulted in increased drug costs.
Cancer drug wastage can increase drug costs but is not uniformly modeled in economic evaluations. Cancer 2017;123:3583-90. © 2017 American Cancer Society.
本研究旨在确定癌症药物浪费在经济评估中的影响，因为基于体表面积或体重的剂量方案可能导致单剂量小瓶药物浪费。
从 2015 年 1 月起，我们从全加肿瘤药物审查（pCODR）计划中确定了静脉化疗药物。审查了制造商和 pCODR 进行的经济评估。对于无浪费和最大浪费情况（即在每次输注时丢弃小瓶中未使用的全部剩余部分）进行成本效益分析和预算影响分析。对一系列体表面积和体重进行了敏感性分析。
分析了用于 17 种适应症的 12 种药物。71%的模型报告了药物浪费（即假设明确），制造商将其纳入了 53%；这导致增量成本效益比平均增加了 6.1%（范围为 1.3%-14.6%）。pCODR 报告并纳入了 59%的模型的浪费，这导致增量成本效益比平均增加了 15.0%（范围为 2.6%-48.2%）。在最大浪费情况下，增量成本效益比平均增加了 24.0%（范围为 0.0%-97.2%），3 年总增量预算成本平均增加了 26.0%（范围为 0.0%-83.1%），全国 3 年总增量药物预算成本增加了约 1.02 亿加元。改变平均体表面积或体重导致 45%的药物改变小瓶的大小和/或数量，从而增加了药物成本。
癌症药物浪费会增加药物成本，但在经济评估中并未统一建模。癌症 2017；123：3583-90。©2017 美国癌症协会。
