Background The great innovation of ipilimumab (available in our country since 2013) has been accompanied by a high cost that is a heavy burden for our NHS.
Purpose In order to contain the cost of ipilimumab, our hospital has established the Drug Day, with the objective of concentrating in a single day all patients who receive the same drug.
Material and methods With the collaboration of the Oncological-Immunotherapy department, we arrange two consecutive Drug Days (Thursday, Friday). The 21-day cycle of Ipilimumab administration helps us schedule these every 3 weeks, to avoid wasting the drug.
Results Advantages: The first day we prepared ipilimumab (3 May 2013), three patients were scheduled. The total dose was 693 mg, so we used 2 vials of 50 mg and 3 vials of 200 mg. If we had had patients on different days, we would have used 6 vials (750 mg) instead of the 700 mg that we actually used: we saved 1 vial of 50 mg which costs €2,953.
Remaining problems: The short stability of ipilimumab (24 h after reconstitution) restricts the potential of ipilimumab Drug Day. An example: on 5–6 December 2013 we had two patients per day who received the same dose (453 mg). If we could have used what was left over from the previous day we would have saved at least 1vial of ipilimumab 50 mg in two days.
Conclusion From the introduction of ipilimumab in our hospital, to the end of 2013, we treated 27 patients, with 90 administrations, concentrated in 40 Drug Days. This saved €70,884. The system could be further improved if patients in the area of our hospital could have their blood tests on Thursday, then receive the drug (preparation at around 9:00 am) on Friday; this would allow us to move within 24 h stability, thus permitting the reuse of vials used on Thursday (prepared at around 12:00 pm).
Reference and/or Acknowledgements No conflict of interest
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