OBJECTIVES

Cancer is one of the major causes of mortality and represents a significant burden of disease. Due to the complexity of chemotherapy regimens, medication errors can occur at any point from prescribing to administration. Today, pharmacists play an important role in rationalizing consumption and prescription of medicines for patients undergoing chemotherapy. Intervention of the pharmacist, as one of the last members of the treatment team, can reduce adverse drug events (ADEs) and ultimately save costs. This study estimated the cost–benefit ratio of pharmacist interventions over a year in a chemotherapy preparation unit at a referral hospital in Iran in which annually about 10,000 cancer patients receive inpatient and outpatient care.

METHODS

Pharmacist intervention records from Sep 2017 to Aug 2018 collected in a standard checklist in Cancer Institute, Tehran University of Medical Sciences, Iran.The clinical significance of interventions was rated by one oncologist and one clinical pharmacist according to Common Terminology Criteria for Adverse Event (CTCAE). Benefit was estimated through both cost avoidance based on the potential to avoid an ADE and cost savings related to reducing discarded products. Cost was estimated from the pharmacists' salary corresponding to the time spent in reviewing chemotherapy prescriptions. Finally, the analysis was conducted by calculation of the cost-benefit ratio.

RESULTS

Among 18,450 cancer chemotherapy prescriptions, 559 interventions were applied. Most cases of interventions were related to dosage adjustment of the prescribed dosage (36.4%). 78% of the interventions were considered as clinically more than significant. The cost-benefit analysis showed a clear cost benefit with a cost-benefit ratio of 2.3-16.6 (depends on clinical significance):1.

CONCLUSIONS

Positive impact of pharmacists’ interventions on the clinical and economic outcomes of chemotherapy drugs was clearly demonstrated in this study. This service could reduce medication errors, preventable ADEs, as well as costs of both medications and potential ADEs.