“We do not believe that this phenomenon is accidental,” said Dr Bach.

The researchers also noted that the practice of “flat” or “fixed” dosing, in which clinicians round up doses to the full vial quantity, is also problematic.

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“Flat dosing of drugs already marketed to be dosed by body weight, allowing the full amount of each vial to be used, does not solve the waste problem,” Dr Bach said. “It simply hides it by placing the excess drug into the patient, instead of discarding it.”

Dr Bach noted that regulatory standards regarding dosing are conflicting and ambiguous, and called for the consideration of a number of policy options.

“We pose several solutions to this problem, including requiring manufacturers to package drugs in quantities that allow for minimal wastage, or enabling the ‘virtual return’ of leftover drug, paying only for drug that is appropriately given to the patient,” he said.

In the analysis, the researchers estimated that adopting these policy suggestions could reduce overspending due to leftover drugs by $1.4 billion and by as much as $2 billion if markups to clinicians and hospitals are included.

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“As health care expenditures continue to rise, opportunities to reduce waste have become increasingly important,” said Dr Bach. “It is necessary to be aware of the fact that as a system, we are not only paying for the dose that is being administered to the patient, but also for drug that is going directly into the trash. Not only is this illogical, but it is an unnecessary source of waste that could be easily minimized.”


  1. Bach PB, Conti RM, Muller RJ, et al. Overspending driven by oversized single dose vials of cancer drugs. BMJ. 2016;352:i788.