Background Many rheumatology patients have chronic treatment with low-dose subcutaneous methotrexate. Commercial methotrexate syringes are available in limited dosages. There is evidence of health risks from reconstitution and handling of methotrexate vials in specialist or Primary Health Care clinics.

Purpose To devise a system for collaboration between the Hospital Pharmacy Department and Primary Health Care; to improve safety and reduce costs.

Materials and methods From February 2011 to August 2013, all the medical charts of rheumatology patients given subcutaneous methotrexate were reviewed and prescriptions were validated. The Pharmacy Department carried out the preparation and labelling of the syringes in a cytostatic safety cabinet and the department courier service distributed them to all Primary Health Care clinics. Every clinic was provided with cytostatic waste bins.

Results The hospital pharmacist validated the prescriptions of 147 different patients (average: 68.4 patients a month). During the study period, 8434 syringes were prepared, but 918 doses (10.8%) were individualised doses that didn’t have a commercial presentation. With an average cost of 26.6 € per commercial syringe, the theoretical cost was calculated at 227,420 €, considerably more than 4,898 € which was the cost of the 3,655 vials of methotrexate used. The cost for preparing was 2,508 € for the pharmacy technician. Thus, this system will offer an estimated budget saving for the Health Department of approximately 220,014 €.

Conclusions Central production was safer; at the same time we checked the suitability of prescriptions, adherence to treatment, introduced appropriate waste management and found a savings opportunity. An important saving can be made by preparing methotrexate syringes centrally for all Health Department patients.

No conflict of interest.