Dürr Pauline, Schlichtig Katja, Krebs Sabine, Schramm Anja, Schötz Lukas, Fromm Martin F, Dörje Frank
Lehrstuhl für Klinische Pharmakologie und Klinische Toxikologie, Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland; Apotheke des Universitätsklinikums Erlangen, Erlangen, Deutschland; Comprehensive Cancer Center Erlangen-EMN, Erlangen, Deutschland.
Lehrstuhl für Klinische Pharmakologie und Klinische Toxikologie, Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland; Comprehensive Cancer Center Erlangen-EMN, Erlangen, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2022 Apr;169:84-93. doi: 10.1016/j.zefq.2022.01.002. Epub 2022 Mar 3.
The number of prescriptions and costs of oral anticancer drugs are increasing. Therapy discontinuation due to, for example, side effects, progression, or death, often lead to medication wastage. While evidence exists for the economic value of wasted injectable chemotherapeutics, there is a lack of data for oral anticancer drugs in Germany.
The multicenter AMBORA trial investigated 202 patients, who had been newly started on new oral anticancer drugs, over 12 weeks and analyzed the outpatient prescription data of patients who discontinued treatment. The amount of medicines wasted and their costs were determined using the pharmacy retail price. Defined daily doses and prescription data from the AOK Bayern, a German statutory health care insurance company, were used to extrapolate these costs.
Within 12 weeks, 24.8 % of the AMBORA patients discontinued oral anticancer treatment (50 of 202). Prescription data of 34 patients were evaluable. In total, 1,693 tablets/capsules with a value of 112,212 euros were wasted. The approximate extrapolation to the prescription volume of the AOK Bayern resulted in an estimated wastage of 3.49 million euros in 12 weeks.
Medication wastage due to discontinuation of new oral anticancer drug therapy leads to a considerable financial burden. Regarding rising prescription numbers and therapy costs in oncology, measures to reduce wastage of oral anticancer drugs should be initiated.
Clinical pharmacological / pharmaceutical care including medication reconciliation and review, side effect management and patient counseling to optimize adherence and medication intake behavior, contributes to a reduction of therapy discontinuations, thereby reducing drug wastage. To further reduce drug wastage small (initiation) packages, which are currently not always available for an economic prescription, play an important role. The practice of partial prescription fills, which is already practiced internationally, should also be further discussed in Germany.
口服抗癌药物的处方数量和费用正在增加。例如，由于副作用、疾病进展或死亡导致的治疗中断，常常会造成药物浪费。虽然有证据表明浪费的注射用化疗药物具有经济价值，但德国缺乏口服抗癌药物方面的数据。
多中心AMBORA试验对202例新开始使用新型口服抗癌药物的患者进行了为期12周的研究，并分析了中断治疗患者的门诊处方数据。使用药房零售价确定浪费的药品数量及其成本。利用德国法定医疗保险机构AOK拜仁的限定日剂量和处方数据来推断这些成本。
在12周内，24.8%的AMBORA患者中断了口服抗癌治疗（202例中的50例）。34例患者的处方数据可评估。总共浪费了1693片/粒胶囊，价值112,212欧元。对AOK拜仁处方量的大致推断结果显示，12周内估计浪费349万欧元。
新型口服抗癌药物治疗中断导致的药物浪费会带来相当大的经济负担。鉴于肿瘤学领域处方数量和治疗费用不断上升，应采取措施减少口服抗癌药物的浪费。
临床药理学/药学监护，包括用药核对与审查、副作用管理以及患者咨询，以优化依从性和用药行为，有助于减少治疗中断，从而减少药物浪费。为进一步减少药物浪费，小包装（起始装）目前在经济处方中并非总是可用，但其起着重要作用。国际上已采用的部分处方配药做法，在德国也应进一步探讨。
