Financial impact of oral chemotherapy wastage on society and the patient.

Background Targeted oral agents are now increasingly being utilized in cancer treatment, but are expensive. Changing the dose of these medications due to toxicity or discontinuation secondary to disease progression or death causes waste from unused medication. Limiting waste is an important goal, as waste has a substantial financial impact on patients and insurance companies. Methods Patients started on oral targeted agents' sunitinib, everolimus, axitinib, or vemurafenib between January 2012 and February 2015 who obtained their medications at Holden Comprehensive Cancer Center specialty pharmacy were included in the analysis. We acquired dispensing data retrospectively for each of the agents and reviewed patient charts. Wasted tablets/capsules were calculated from their last fill to the dates of stoppage or dose adjustment. The amount associated with the wastage was calculated using the average wholesale price. Repository drug usage data during the same time period was obtained. Results Eighty-eight patients had their prescriptions filled at Holden Comprehensive Cancer Center during the study time period. Waste occurred in 41% of all patients with primary reasons attributed to cancer progression in 25 patients, death in five patients, toxicity in five patients and increase in dosage of targeted therapy in two patients. A total of 1179 tablets or capsules were wasted from all causes, priced at a total of $248,595.69. Conclusion Oral chemotherapy medications are associated with wastage, which is a significant financial burden to society. Progression of disease emerged as the single most important factor accounting for wastage. Novel ideas are needed to prevent wastage, thereby reducing healthcare costs.