Drug wastage—the bane of pharmacy practice—and trying to avoid it is drummed into the head of retail pharmacists around the country. It is one thing to talk about wastage for a generic beta blocker for hypertension, for which the cost is nominal, but for a highercost chemotherapeutic agent, the amount of money lost in drug wastage is assumed to be very high—or is it? Pharmacists from the Veteran Affairs Health Care Center in Palo Alto, California, sought to quantify how much could be saved by enforcing the common practice of “rounding down” chemotherapy doses to the nearest vial unit size in their ambulatory infusion center, thus reducing or eliminating wastage of certain products.

The pharmacists reviewed the records of patients given infused chemotherapy over six months, ending April 30, 2007. Drug acquisition costs were used to estimate how much wastage was avoided in patients whose doses were rounded down and how that translated into cost savings to the center.

They found that one-quarter of the 333 patients receiving infused chemotherapy had their doses rounded down an average of 2% to the next vial size over the six months. The amount of chemotherapy saved was 2.3 g (230 mL), and the creation of 40 partial vials. The pharmacists calculated that the cost saved by the health care center was $6,600, which is the equivalent of $13,100 based on average wholesale price.

Although they did not study the clinical outcomes in the patients with cancer who received the lower doses, rounded down to the next vial size, the researchers believe that the practice does save significantly in drug acquisition cost and spares needless environmental waste.

Nguyen C, Miyahara RK, Joshi R: Cost avoidance associated with rounding down chemotherapy doses by a pharmacist in the ambulatory infusion center. Presented at the 2008 annual meeting of the Academy of Managed Care Pharmacy, San Francisco, April 16–19, 2008.