Study Examines Impact of Vial Sizes on Drug Waste of Multiple Myeloma Treatment
A group of researchers investigated the impact of vial sizes on drug waste and cost when using bortezomib and carfilzomib to treat patients with multiple myeloma. Bortezomib is only available in a single vial size (3.5 mg single-dose vials [SDV]) and carfilzomib is available in multiple vial sizes, including 60 mg, 30 mg, and 10 mg SDVs.
The researchers used administrative claims data from patients enrolled in Medicare between 2017 and 2022 from 15 practices in The US Oncology Network for the study. To determine the financial impact of the vial sizes, they utilized Medicare's average sale price-based reimbursement data from the calendar quarter of when the drug was administered. Using the Healthcare Common Procedure Coding System JW modifier attached to paid claims, they analyzed the billed units to measure drug waste. They also looked at the trends in drug waste over time for both medications and assessed the impact after the 10 mg SDV for carfilzomib was introduced in 2018.
The study found that when 3.5 mg SDV of bortezomib was used for the preparation of patient-specific doses of 1.3 mg/m2 of body surface area (BSA), the remaining partial vial was wasted in 92.4% of the 100 685 administrations reviewed. In contrast, as carfilzomib may be prepared using a combination of different vial sizes, there was less waste for this group. With patient- and regimen-specific doses (20/27/56/70 mg/m2 of BSA), there was waste in 66% of the 34 954 administrations of carfilzomib reviewed.
In terms of cost, the results showed that from 2017 to 2022, the total billed dose wasted of bortezomib was greater than the total billed dose wasted of carfilzomib (30.6% vs 8.1%, respectively). The introduction of the smaller 10 mg SDV for carfilzomib led to a reduction in waste by more than 70% to 4.75% of the total billed dose, resulting in a cost savings of $7.4 million. However, following this introduction, the average number of individual vials used per administered dose increased from 1.4 to 2.3 vials, which totaled 20 687 vials.
“The financial consequences of drug waste are significant, resulting in the potential loss of millions of dollars each year within health care systems,” wrote the authors. The researchers note that using smaller and multiple vial sizes can help mitigate drug waste. Other strategies mentioned include manufacturing vials in smaller sizes, adopting multi-dose vial packaging, implementing dose rounding or banding initiatives, and establishing shared-vial programs to redistribute remaining drugs.
Reference
Indurlal P, Garey J, Neeb J, Wilfong L, Burke J. The economic impact of vial sizes on drug waste of bortezomib and carfilzomib in multiple myeloma: the US Oncology Network study. Presented at: the 2024 Clinical Pathways Congress and Cancer Care Business Exchange. September 6-8, 2024; Boston, MA; Abstract MCK002
