Preparation of intravenous chemotherapy bags: evaluation of a dose banding approach in an Italian oncology hospital
Marco Chiumente, Alberto Russi, Federica Todino, Daniele Mengato, Marina Coppola, Melania Rivano, Angelo Claudio Palozzo, Claudio Jommi
Farmacoeconomia ed economia sanitaria
Dose banding is an original approach that manages IV chemotherapy preparation by generating on a weekly basis a series of bags containing scaled dosages of the active agent. These predetermined, fixed dosage bags are intended to replace the traditional, bags prepared daily that contain fully individualized dosages.
Three different scenarios were examined: #1) the current method of daily preparation of individualized bags at the hospital pharmacy; #2) the weekly preparation at the hospital pharmacy of non-individualised bags containing discrete, predefined doses covering an adequate range of doses (dose banding); #3) the use of commercial ready-to-use bags based on the same approach of dose banding. The objective of this study was to compare these three different approaches in terms of cost per patient. We considered 5 cancer drugs (gemcitabine, oxaliplatin, paclitaxel, trastuzumab and 5-fluorouracil) that were suitable for the dose ranging approach. Appropriate dose bands for these 5 agents were identified. Costs were estimated for each of the three approaches.
A total of 13,490 fully individualized bags were studied, which corresponded to the real bags prepared at our institution for these 5 agents in 2018. Dose banding was predicted to determine savings ranging from 10,998 euro (-0,84%) for trastuzumab to 169,429.60 euro (-8,39%) for paclitaxel.
The introduction of dose banding can determine economic savings along with other advantages, such as improved work conditions, management reorganization and containment of waste. The pharmaceutical industry can hopefully support these experiences by producing ready-to-use bags in pre-determined dosages.
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