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6ER-005 Drug wastage: a hidden cost of cancer care
  1. AB Pousada Fonseca,
  2. D García Martinez,
  3. MJ Vázquez Castillo,
  4. Y Mateos Mateos,
  5. I Gonzalez García,
  6. MR Mengual Barroso,
  7. A Gonzalez Fuentes,
  8. F Fernandez Fraga,
  9. B Rubio Cebrián,
  10. M Mañes Sevilla,
  11. M Segura Bedmar
  1. Hospital Universitario De Móstoles, Hospital Pharmacy, Móstoles, Spain


Background and Importance Our country’s legislation bans the return of dispensed drugs to Pharmacy Services, potentially leading to increased costs for the National Health System.

Aim and Objectives To estimate the cost of pill wastage due to dose modifications and discontinuation for oral anticancer drugs.

Material and Methods Retrospective economic evaluation carried out in an intermediate complexity hospital. Using the electronic medical record, dispensations of oral anticancer drugs between July 2022 and July 2023 were identified.

The following variables were collected drug, date of dispensing, tablets dispensed, date the patient needs to return to the pharmacy, treatment interruption and cause, date of interruption and leftover tablets.

The laboratories’ sales prices were used to calculate the costs. We calculated the potential number of dispensations that the wastage could have covered by dividing the total wastage by the median price per dispensation.

Dose modifications were not taken into account in drugs which had pill strengths divisible at each dose-reduction level.

Unmarketed drugs in our country were excluded.

Results 1239 dispensations were identified. The most dispensed drugs were enzalutamide 40 mg with 308 dispensations (25%) ribociclib 200 mg with 219 (18%), niraparib 100 mg with 143 (12%) and lenvatinib 10 mg with 66 (5%). The median number of days for which medication was dispensed was 30 [IQI 28–35]. The median price per dispensing was €3,173 [IQI 1,866–4,445] and the total annual expenditure was €3,759,172.

63 (5%) dispensations were interrupted. The most frequent causes were disease progression for 33 drugs (52%) and toxicity for 19 (30%). The median price per dispensing was €3,173 [IQI 1,155–4,445] and the total price was €186,327.

In 34 of the interruptions (54%) patients had tablets remaining. The median wastage per patient was €1,393 [IQI 645–2,503] and the total wastage was €56,459 (1.5% of the annual expenditure and 30.3% of the discontinued treatments).

Seventeen dispensations (1.4%) could have been covered with the total cost of pill wastage.

Conclusion and Relevance Although few treatments were discontinued, significant economic wastage occurred due to drug prices. To minimise it, it has been suggested that companies refund money for unused tablets and manufacture appropriate pill strengths¹. Additionally, hospital pharmacists could be empowered to decide on the return of medications.

References and/or Acknowledgements 1.

Conflict of Interest No conflict of interest.

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