Cost analysis of closed-system transfer devices in bortezomib handling in a Brazilian cancer center

IntroductionMultiple myeloma (MM) is a common hematologic cancer treated with bortezomib, a 26S proteasome inhibitor supplied by the Brazilian Unified Health System (SUS). Limited post-reconstitution stability leads to drug waste, though studies suggest longer stability if sterility is maintained. Closed-system transfer devices (CSTDs) may enable safe reuse and reduce waste.This study evaluated, using a cost-focused simulated model based on retrospective consumption data, the impact of incorporating the CTSD on direct hospital costs related to the handling of the last bortezomib vial of each day in a Brazilian public oncology hospital.MethodsRetrospective observational and quantitative study, considering all bortezomib vials used in a brazilian hospital between January 1 and December 31, 2024. Prescribed, used, and discarded volumes were analyzed. An alternative scenario with CSTD use was simulated, allowing reuse of leftovers for up to seven days, based on literature data regarding physicochemical and microbiological stability.ResultsIn 2024, 245 patients received bortezomib. A total of 4296 doses were administered, consuming 2837 vials. The CSTD simulation reduced 114 vials but resulted in a 2.76% increase in total cost (R$ 125,789.92 vs. R$ 122,416.55). An increase in treated patients (256 vs. 245) and completed cycles (1118 vs. 1074) was observed.ConclusionAlthough direct cost reduction was not achieved, CSTD use may eliminate waste, expand patient access, and optimize public healthcare resources.