Mitigation strategies could save 15% to 17% of parenteral anticancer drug costs annually, according to a study published in the Journal of Oncology Practice.1

The direct cost of cancer care in the United States is estimated at $74 billion and is expected to double as a result of novel drug development and the aging population. Cost-effectiveness studies typically assume that every milligram of drug is used. Drug waste occurs, however, when the entire volume of a parenteral drug is not administered.

This study evaluated the extent of drug wastage and the financial implications, as well as the effect of mitigation strategies.

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An example of a mitigation strategy is sharing a single-use vial if it remains in International Standards Organization class 5 conditions. Most pharmacies, however, use the standard of 1 patient, 1 drug under the fume hood at any a given time.

This multicenter study of outpatient chemotherapy pharmacies of 3 Canadian hospitals calculated hypothetical drug wastage with and without mitigation strategies during a 2-week period in June 2015. Prescription doses, available vial sizes, and the actual amount of drug wasted were considered.

The highest waste potential was identified among single-dose vial cancer drugs and included azacitidine, bendamustine, bevacizumab, bortezomib, cabazitaxel, pegylated liposomal doxorubicin, eribulin, ipilimumab, trastuzumab emtansine, nab-paclitaxel, oxaliplatin, panitumumab, and rituximab.

The hypothetical full wastage was 16% to 18% of the cost of a drug, translating to $69,284 to $149,131 Canadian dollars. The actual wastage with current mitigation strategies in place was 0.8% to 1.8% of the drug cost, or $928 to $5472.

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The hypothetical annual full wastage cost for the hospital was up to $22.5 million and annual savings with mitigation strategies were estimated to be 15% to 17%.

The authors wrote that “the findings generated from this study will serve as pilot data to guide future projects to examine the full impact of drug wastage and the ability of available mitigation strategies to limit the financial burden.”


  1. Leung CY, Cheung MC, Charbonneau LF, Prica A, Ng P, Chan KK. Financial impact of cancer drug wastage and potential cost savings from mitigation strategies. J Oncol Pract. 2017 Jun 12. doi: 10.1200/JOP.2017.022905 [Epub ahead of print]