Optimizing chemotherapy practices: The impact of dose banding on reissuing and waste reduction

ObjectivesDose banding has been introduced to prevent waste caused by cancellation of the chemotherapeutic agents paclitaxel, carboplatin, docetaxel, gemcitabine, irinotecan and oxaliplatin. This could enhance the interchangeability of reconstituted chemotherapy, improving sustainability and cost-efficiency in healthcare. The aim of this project is to evaluate the impact of dose banding on the increase of reissuing admixtures and reduction of medication waste.MethodsDose bands were created, allowing a maximum deviation of 10% from the prescribed dose. These dose rounding rules were implemented in Hix 6.2 (ChipSoft BV). Drug waste (already prepared admixtures) and reissuing of admixtures were compared one year before and after implementation. Admixtures eligible for reissuing were identified, and reissued preparations were quantified as percentages of total eligible treatments. Economic benefits were calculated using product, material and preparation costs.ResultsPost-implementation, reissuing increased for all chemotherapies except carboplatin. The largest improvement was seen for oxaliplatin, where reissuing increased from 3.7% to 27.8%, which is an absolute increase of reissuing from 1 to 5 admixtures. Waste was reduced for all agents except carboplatin, with paclitaxel 80 mg/m² showing the greatest reduction, an absolute reduction of already prepared admixtures from 90 to 23. The amount of waste was significantly reduced, resulting in yearly cost savings of approximately €5,200.ConclusionsDose banding enhances the reissuing of chemotherapeutic agents by increasing interchangeability. Broader implementation of this straightforward procedure could further improve reissuing and reduction of waste in chemotherapy preparation.