OBJECTIVES: Assessing economic loss by cancer drug wastage in 3 months (October-December 2018) and retrospective analysis of drug usage in previous 3 months.

METHODS: Electronic balance (MAB220, Wenser®) was set up in the preparation room. Drugs for solid malignancies (liquid dosage form) were pre-weighed and post weighed to find drug remaining in vial. Estimated drug loss was assessed by finding difference between quantity in vial and dose required for patient. Actual drug loss was assessed by direct conversion of left-over drug in vials into money value.

RESULTS: Analysed 423 prescriptions over 6 months. Number of patients were 163 with 53% (n= 87) females. Mean (SD) age was 51(14) years. The mostly prescribed drugs were carboplatin (n=60, 37%), paclitaxel (n=57, 35.2%), oxaliplatin (n=34, 21%) and epirubicin (n=22, 13.6%) and diagnosis was carcinoma Stomach (16%). Total expenditure on drugs (6 months) was Rs.3981625 with median (IQR) cost per prescription was Rs.9000 (7131). Estimated total drug wastage costs Rs.759064 (6 months).The economic loss due to drug wastage was 19.06% of the total expenditure on drugs alone. Highest percentage of average loss per prescription was for pemetrexed (46.45%). Percentage of available vial strengths exactly matching the patient requirement was 87.9, 50, 47.8, 33.9, 26.8, 22.8,21.2, 20.0, 18.2,13.5, 13.3, 4.3, 3.6 for cisplatin, etoposide, irinotecan, gemcitabine, epirubicin, paclitaxel, doxorubicin, docetaxel, carboplatin, cyclophosphamide, oxaliplatin, 5FU and pemetrexed respectively. There was no significant difference between estimated drug wastage and quantitated drug wastage in three months (Rs.390951 vs. 393375, p=0.210)as well as for age ,(p=0.909) and gender (p=0.920) on the drug wastage.

CONCLUSIONS: There is significant drug wastage of chemotherapeutic agents in the day care setting. One-fifth of the expenditure on drugs is getting wasted. Exact vial strength is available only on an average of one-fourth of the prescriptions. There were no other significant variables related to drug wastage.