Drug vial optimization reduces waste, saves costs

PHOENIX — Drug vial optimization resulted in 94% reduction in drug waste and over $43 million in cost savings, according to a presentation at the Association of Community Cancer Centers National Oncology Conference.

“Drug vial waste does create several difference issues,” Lindsey B. Amerine, PharmD, MS, BCPS, associate director of pharmacy at University of North Carolina Medical Center and associate professor of clinical education at UNC Eshelman School of Pharmacy, said during her presentation. “You not only have costs, you have disposal issues. Your institution has to find ways to dispose of the hazardous medication appropriately, and then obviously you have potential exposure risk because you still have drug left in the vial.”

Amerine and colleagues implemented a comprehensive drug vial optimization program to help save costs and address these issues.

Cost savings

Before the program implementation, UNC Medical Center reported annual costs of drug wastes of $770,900.

Seven years after implementation, drug-vial optimization had reduced drug waste costs by 94%, to $49,000. Drug waste costs have remained steady in the last few years.

Amerine estimates that drug vial optimization has provided a $43.8 million reduction in her institution’s drug budget in 2018, from $90.6 million to $46.8 million.

“A lot of that is [because] we’re reusing vials and we can actually treat more patients with the same amount of drug that we’ve already purchased,” Amerine said.

The program also resulted in buying fewer closed-system transfer devices, which are used one-per-vial to keep hazardous drug and vapor concentrations in the vial and environmental containments out of the vial, leading to further cost savings.

Drug vial optimization also appeared safe for patients. Researchers did not observe increases in rates of central line-associated bloodstream infections.

Monthly in-house quality assessment showed no contamination of the vials. During the first quality assessment, Amerine and colleagues observed two vials that may have had contamination, but a microbiologist determined those were due to user error during the quality assessment.

“We have data that do exist that demonstrate the ability of drug vial optimization to safely extend the drug vial contents using a closed system transfer device,” Amerine said. “A comprehensive drug vial optimization can decrease your drug waste while mitigating risk.”

Implementing drug vial optimization

Drug vial optimization begins with a research-supported closed-system transfer device, according to Amerine. The program also needs to implement a drug compendium which lists the stability and beyond-use date for every drug prepared by the cancer hospital, as they vary from drug to drug.

Research has shown that drug vials can be stored and reused up to 7 days after first use, or until the chemical stability of the drug is compromised, whatever comes first, when using closed- system transfer devices. This research was the rationale behind implementing drug vial optimization, according to Amerine.

Amerine and colleagues also completed staff training and continuing education to maintain best practices for preparing medication, as well as understanding of the new process.

New vials are labeled with a barcode or sticker to indicate the beyond-use date. Partially used vials are placed in a designated location, and pharmacist technicians have been trained to look for partially used vials before opening a new vial.

Electronic records have also helped keep track of partially used vials to further eliminate waste.

“Drug prices continue to increase ... so, for us, [the drug vial optimization program] really been a great program that has allowed us to take those cost savings and invest in other ways to help our patients,” Amerine said. “The volumes are not going away at this point, and we want to be able to treat as many patients as we can. From a shortage perspective, it’s also helped us out there, where we can make sure we can get the most out of all the vials that we’ve already purchased.” – by Cassie Homer

Reference:

Amerine LB. Combating rising drug prices & waste through drug vial optimization.Presented at: ACCC National Oncology Conference; Oct. 17-19, 2018; Phoenix.

Disclosure: Amerine reports a speaking role with Becton Dickinson and advisory board roles with Amgen and Bristol-Myers Squibb.