Medicines

Wasting away: left over cancer drugs costing billions


Oversized single dose vials of cancer drugs means the US throw away an estimated $3 billion worth of unused drugs each year, researchers say.

The team of authors from the Memorial Sloan Kettering Cancer Centre in New York call for an end to ‘contradictory regulatory standards’ that allow drug manufacturers to boost profits by producing single dose vials containing quantities that increase leftover drug.

Increasing the amount of drug sold per treated patient also increases profits to doctors and hospitals in the United States, the researchers noted.

To get to grips with the extent of the problem the research team reviewed the waste generated by the top 20 selling cancer drugs packaged in single dose vials and dosed based on body size.

“We focused on the US because, unlike in most other Western countries, the government plays no role in how drugs are priced and doctors and hospitals can profit from leftover drugs,” they wrote in their paper which was published in the BMJ.

They estimated that insurers pay drug makers $1.8 billion each year on discarded medications and another $1 billion on price markups to doctors and hospitals.

The analysis showed the proportion of drug left over varied from 1% to 33% between drugs and the effect of different approaches to packaging was illustrated by the two drugs bendamustine and bortezomib.

For instance estimated waste for the leukaemia drug bendamustine was 1% whereas 27% to 30% of bortezomib sales in the US were related to leftover, they estimated.

The researchers said the problem of mismatched single dose vials and doses was not unique to cancer.

The asthma drug omalizumab has approved doses in 75 mg intervals, but the company only sells 150 mg vials in the United States, even though it has an approved 75 mg vial size. The drug infliximab was available in only 100 mg single dose vials and was also dosed based on body size.

The current regulatory standards in the US were contradictory, or at least as ambiguous, the researchers said.

“Policy makers should explore approaches that would reduce or eliminate paying for leftover drug,” they concluded.

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