Cost of Drug Wastage From Dose Modification and Discontinuation of Oral Anticancer Drugs

Author(s): Michael Lam, PharmD¹; Timothée Olivier, MD^2,3; Alyson Haslam, PhD³; Jordan Tuia, BA³; Vinay Prasad, MD, MPH³

Source: JAMA Oncol. 2023;9(9):1238-1244. doi:10.1001/jamaoncol.2023.2306

Dr. Anjan Patel's Thoughts

An interesting study showing that, on average, a cancer patient wastes >$4000 on unused drugs due to discontinuation of oral agents or dose modifications. Allowing a safe recycling method for patients to submit unused drugs could save a lot of wasted healthcare dollars.

IMPORTANCE

Oral chemotherapy is often dispensed to patients as a 1-month supply, with pill dose and package size predetermined by the drug manufacturer; thus, changing the patient dosage may waste the remaining initial drug supply. The cost of pills wasted due to dose modification and discontinuation is often unreported.

OBJECTIVE

To estimate the cost of pill wastage due to dose modification and discontinuation for oral anticancer drugs that were recently approved by the US Food and Drug Administration (FDA) or that are commonly prescribed.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cross-sectional economic evaluation initially identified 26 oral anticancer drugs newly approved between January 1, 2020, and August 31, 2022, from the FDA website and the top 50 best-selling pharmaceuticals in 2021 abstracted from the Drug Discovery Trends website managed by Drug Discovery and Development. The monthly costs of each agent were extracted from the Micromedex RED BOOK database. The FDA package insert, and in some cases PubMed, of each identified drug and indication was searched (matching on trial registration number) for information on registration trials. Information extracted for each drug included the name of the drug approved, drug target, cost of the drug, number of pills per bottle, available strengths, indication, name of the trial, number of patients exposed to treatment drug, number of dose level reductions, median duration of treatment, percentage of patients who received dose reduction, and percentage of dose discontinuation. All variables included in calculations were derived from the package insert or original trial publication.

MAIN OUTCOMES AND MEASURES

The cost of wastage for selected oral anticancer drugs due to dose reduction or discontinuation and the percentage of wastage in comparison with the total cost of treatment.

RESULTS

After removing duplicates, 22 oral anticancer medications were included in the study. Because some drugs had more than 1 indication, data from 35 clinical trials were analyzed. Eight of the medications (covering 9 indications) had pill strengths divisible at each dose-reduction level; thus the cost of reduction for these pills was assumed to be zero. Two medications did not allow for dose reduction. The median cost of wastage from dose reduction and discontinuation was $1750 (range, $43-$27 200), with a mean cost of $4290 (SD, $5720) per patient. The median percentage of wastage from the total cost of treatment was 1.04% (range, 0.04%-10.80%) with a mean of 1.78% (SD, 2.21%).

CONCLUSIONS AND RELEVANCE

This economic evaluation found that due to both the high cost per pill and limited pill strength availability, the mean cost of wastage associated with dose reduction or discontinuation was $4290 per patient. These results suggest that to reduce the financial burden for patients with cancer, regulatory bodies should enforce availability of pill strengths that will limit pill wastage during dose modification or recommend that drug manufacturers issue credit for unused pills.

Author Affiliations

¹School of Pharmacy, University of California, San Diego, La Jolla; ²Department of Oncology, Geneva University Hospital, Geneva, Switzerland; ³Department of Epidemiology and Biostatistics, University of California, San Francisco

1 thought on “Cost of Drug Wastage From Dose Modification and Discontinuation of Oral Anticancer Drugs”

Gus Fonseca
October 6, 2023 at 4:28 pm

In the past months with the shortage of so many vital generic I had been wondering if this is not the moment to ask advocacy groups to take on the waste of our very expensive drugs (oral & IV)

Reply

The Future of Home and Community Care

This article provides a sweeping historical and modern day perspective on the care delivery ecosystem beyond the four walls of a hospital. While site of care (hospital, community, home, remote, etc.), and its appropriateness / value remains a hot topic of debate, there is no questioning that ultimately the best interests of the patient should govern where care is received / delivered. For oncology/hematology patients, safe, convenient and high quality / low cost care is best received in community settings, like here at Florida Cancer Specialists & Research Institute.

Compliance of National Cancer Institute–Designated Cancer Centers With January 2021 Price Transparency Requirements

While price transparency across sites of care on its face is a step in the right direction, datapoints when viewed discretely are less informative when it comes to the actual costs associated with cancer care. Additional work, analysis and research is much needed across the stakeholder continuum to fully understand the costs associated with the treatment of cancer, and to further achieve the transparency goals set forth by CMS in 2019 with this initiative.

Hospitals and for-profit PBMs are diverting billions in 340B savings from patients in need

STAT News published the below Op Ed from COA that does that highlights the dysfunction of the 340B system and how Hospital Systems and PBMs are profiting Billions of dollars a year off of a program that was intended to help underserved patients. Is a great “high level” review to help understand the overall impact on the US medical system and the importance of health care reform in this area.

Hospital-Administered Cancer Therapy Prices for Patients With Private Health Insurance

Analysis of 61 NCI-designated cancers demonstrate parenteral cancer drug price markups across all centers ranging between 188.4% to 633.6%. Only 27 centers publicly disclose payer-specific prices for cancer therapies as required by federal regulation. Authors recommend public policies to discourage excessive hospital price markups on patenteral chemotherapeutics to reduce financial burden on cancer treatment for patients.

Everybody’s Talking About Value-Based Health Care. Here’s What They’re Not Saying.

Thought-provoking oped highlighting the underbelly of buzzwords in healthcare today. The shift from volume to value that we’ve seen unfold over the past 3-5 years has moved front and center in many conversations, yet remains elusive insofar as its definition and implementation. This article rightly calls out that value is ultimately in the eye of the beholder, and yet there’s no disputing that doing what’s right for the patient trumps all.