Hess Lisa M, Cui Zhanglin Lin, Li Xiaohong Ivy, Oton Ana B, Shortenhaus Scott, Watson Ian A
a Eli Lilly and Company , Indianapolis , IN , USA.
J Med Econ. 2018 Aug;21(8):755-761. doi: 10.1080/13696998.2018.1467918. Epub 2018 May 11.
Lung cancer is one of the most prevalent cancers in the US. This study was designed to evaluate the actual drug wastage and cost to the healthcare system using patient-level retrospective observational electronic medical record (EMR) data from a cohort of lung cancer patients in the US.
Data from the Flatiron Health advanced non-small cell lung cancer (NSCLC) cohort was used for this study. Drug administered amount (in mg) was used to determine an optimal set of available vial sizes to minimize waste. Drug wastage was defined as the difference between the drug amount in the optimal set of vials and the administered amount. Wholesale acquisition costs were used to value the cost of drugs, with and without vial sharing assumptions. The amount and cost of waste were quantified over the 2-year study period (January 2015-December 2016).
There were 8,467 eligible patients included in this study, providing data from 103,826 unique drug administrations across multiple lines of therapy. Overall wastage was 4.37% of the total medication used to care for patients. While costs per administration were low, the total cost of wastage for the study population represented $16,630,112 across the 2-year study period. Assuming that vial sharing occurred at the site level slightly reduced waste to 3.74% (reducing costs to $15,953,212 over 2 years).
Drug wastage is an important concern and has implications on healthcare costs in NSCLC. Evaluation of these real-world data suggest that pharmacists and physicians are able to reduce drug wastage by optimizing vial combinations and sharing vials among patients. Even small amounts of reduction in wastage could be useful in reducing healthcare costs in the US; however, caution is needed with drug rounding efforts to ensure patients do not receive a sub-optimal dose of medication.
肺癌是美国最常见的癌症之一。本研究旨在利用美国一组肺癌患者的患者层面回顾性观察电子病历（EMR）数据，评估实际药物浪费情况以及对医疗系统造成的成本。
本研究使用了Flatiron Health晚期非小细胞肺癌（NSCLC）队列的数据。给药量（以毫克为单位）用于确定一组最佳可用药瓶规格，以尽量减少浪费。药物浪费定义为最佳药瓶组合中的药量与给药量之间的差值。使用批发采购成本对药物成本进行估值，分别考虑有无药瓶共享的假设情况。在为期2年的研究期间（2015年1月至2016年12月）对浪费的数量和成本进行量化。
本研究纳入了8467名符合条件的患者，提供了来自多线治疗的103826次独特药物给药的数据。总体浪费占用于治疗患者的总药物量的4.37%。虽然每次给药的成本较低，但在为期2年的研究期间，研究人群的浪费总成本为16630112美元。假设在机构层面进行药瓶共享，可将浪费略微减少至3.74%（2年内成本降至15953212美元）。
药物浪费是一个重要问题，对非小细胞肺癌的医疗成本有影响。对这些真实世界数据的评估表明，药剂师和医生能够通过优化药瓶组合以及在患者之间共享药瓶来减少药物浪费。即使是少量的浪费减少也有助于降低美国的医疗成本；然而，在进行药物取整时需谨慎，以确保患者不会接受次优剂量的药物治疗。
