Shah Vishal S, Irvine Clayton, McWilliams Robert R, Singh Parminder, Soefje Scott A
Department of Pharmacy, Mayo Clinic, Phoenix, AZ.
Department of Pharmacy, Mayo Clinic, Rochester, MN.
JCO Oncol Pract. 2025 Mar;21(3):400-407. doi: 10.1200/OP.23.00688. Epub 2024 Aug 5.
Globally, cancer drug expenditure exceeds $185 in US dollars (USD) billion, with the United States contributing $75 (USD) billion. Many cancer drug doses are calculated on the basis of body weight or body surface area, which often results in leftover drug in partially used single-dose vials (SDVs). The cost of wasted drug is a huge financial burden on the US health care system. We evaluated the cost savings resulting from the reduction of SDV wastage, achieved through the implementation of automated dose rounding rules in electronic health records (EHRs).
Mayo Clinic implemented automated dose rounding rules within the EHR. These rules were designed to round calculated doses to the nearest SDV if the vial size closely matched the original calculated dose, within a 10% threshold. We assessed doses administered between January 2019 and December 2021, and computed cost-savings, waste reduction, and cost of waste for chemotherapy drugs.
In 3 years, 36.1% of doses were rounded down, 35.8% were rounded up, and 28.1% were exact doses. By rounding doses down to a vial size, we achieved cost-savings of $39.75 (USD) million and prevented 62,065 SDV of cancer drugs from going to waste. By rounding doses up, we avoided wasting $9.95 (USD) million worth of drugs. However, there were still instances where the rounding fell outside of the 10%, resulting in wasted drugs worth $25 (USD) million.
The substantial burden imposed on patients and the US health care system because of cancer drug wastage is of significant concern. Although the automated dose rounding system represents a partial solution for this issue, a comprehensive approach involves the imperative development of policy and legislative solutions to effectively mitigate the challenges associated with cancer drug waste.
在全球范围内，癌症药物支出超过1850亿美元，其中美国贡献了750亿美元。许多癌症药物剂量是根据体重或体表面积计算的，这常常导致部分使用的单剂量瓶（SDV）中有剩余药物。浪费药物的成本给美国医疗保健系统带来了巨大的经济负担。我们评估了通过在电子健康记录（EHR）中实施自动剂量舍入规则来减少SDV浪费所带来的成本节约。
梅奥诊所（Mayo Clinic）在EHR中实施了自动剂量舍入规则。这些规则旨在如果瓶型尺寸与原始计算剂量在10%的阈值内紧密匹配，则将计算出的剂量舍入到最接近的SDV。我们评估了2019年1月至2021年12月期间给药的剂量，并计算了化疗药物的成本节约、浪费减少和浪费成本。
在3年中，36.1%的剂量被向下舍入，35.8%被向上舍入，28.1%为精确剂量。通过将剂量向下舍入到瓶型尺寸，我们实现了3975万美元的成本节约，并防止了62065个癌症药物单剂量瓶被浪费。通过将剂量向上舍入，我们避免了价值995万美元的药物被浪费。然而，仍有舍入超出10%范围的情况，导致价值2500万美元的药物被浪费。
癌症药物浪费给患者和美国医疗保健系统带来的巨大负担令人严重关切。尽管自动剂量舍入系统是解决这一问题的部分方案，但全面的方法需要迫切制定政策和立法解决方案，以有效应对与癌症药物浪费相关的挑战。
