Drug waste minimisation and cost-containment in Medical Oncology: Two-year results of a feasibility study

<p>Abstract</p> <p>Background</p> <p>Cost-containment strategies are required to face the challenge of rising drug expenditures in Oncology. Drug wastage leads to economic loss, but little is known about the size of the problem in this field.</p> <p>Methods</p> <p>Starting January 2005 we introduced a day-to-day monitoring of drug wastage and an accurate assessment of its costs. An internal protocol for waste minimisation was developed, consisting of four corrective measures: 1. A rational, per pathology distribution of chemotherapy sessions over the week. 2. The use of multi-dose vials. 3. A reasonable rounding of drug dosages. 4. The selection of the most convenient vial size, depending on drug unit pricing.</p> <p>Results</p> <p>Baseline analysis focused on 29 drugs over one year. Considering their unit price and waste amount, a major impact on expense was found to be attributable to six drugs: cetuximab, docetaxel, gemcitabine, oxaliplatin, pemetrexed and trastuzumab. The economic loss due to their waste equaled 4.8% of the annual drug expenditure. After the study protocol was started, the expense due to unused drugs showed a meaningful 45% reduction throughout 2006.</p> <p>Conclusion</p> <p>Our experience confirms the economic relevance of waste minimisation and may represent a feasible model in addressing this issue.</p> <p>A centralised unit of drug processing, the availability of a computerised physician order entry system and an active involvement of the staff play a key role in allowing waste reduction and a consequent, substantial cost-saving.</p

Albumin and fibrinogen synthesis and insulin effect in type 2 diabetic patients with normoalbuminuria

OBJECTIVE - Insulin stimulates albumin synthesis but inhibits that of fibrinogen in both type 1 diabetic and healthy subjects. In type 2 diabetes, fibrinogen production is increased both in the postabsorptive state and in response to hyperinsulinemia. No data exist on the rate of albumin synthesis and its response to insulin in type 2 diabetes. RESEARCH DESIGN AND METHODS - We measured fractional synthesis rates (FSRs) and absolute synthesis rates (ASRs) of both albumin and fibrinogen in postabsorptive normoalbuminuric type 2 diabetic patients at their spontaneous glucose levels (study A), as well as albumin FSR and ASR before and after a hyperinsulinemic-euglycemic euaminoacidemic clamp (study B), using leucine isotope methods. RESULTS - In postabsorptive type 2 diabetes (study A), albumin FSR (11.2 \ub1 0.9%/day) and albumin ASR (15.4 \ub1 1.2 g/day) were not different from control values (albumin FSR: 9.4 \ub1 0.7%/day; albumin ASR: 13.8 \ub1 1.2 g/day, P > 0.1 for both). In contrast, in the type 2 diabetic subjects, both fibrinogen FSR (24.9 \ub1 2.1%/day) and ASR (2.4 \ub1 0.2 g/day) were greater (P < 0.025 and P < 0.007, respectively) compared with the control subjects (FSR: 18.6 \ub1 1.51%/day; ASR: 1.6 \ub1 0.2 g/day). Worse metabolic control in the type 2 diabetic patients was associated with hyperfibrinogenemia and increased leucine rate of appearance, whereas neither the (increased) fibrinogen ASR nor the (normal) albumin production was affected. In study B, after hyperinsulinemia (raised to 3c860 nmol/l), albumin FSR and ASR increased by 3c25% versus basal (P < 0.04) and to the same extent in both type 2 diabetic and control subjects. CONCLUSIONS - In normoalbuminuric type 2 diabetic patients, postabsorptive albumin synthesis and its response to insulin were normal, whereas fibrinogen synthesis was increased, irrespective of metabolic control. Furthermore, in normoalbuminuric type 2 diabetic patients, a normal insulin sensitivity with respect to albumin production but a selective hepatic dysregulation of fibrinogen metabolism were present

Long non-coding RNA expression profile in cytogenetically normal acute myeloid leukemia identifies a distinct signature and a new biomarker in NPM1-mutated patients

International audienc

"Hot" drug decrease in waste proportion: 2005 vs 2006, first and second semester

<p><b>Copyright information:</b></p><p>Taken from "Drug waste minimisation and cost-containment in Medical Oncology: Two-year results of a feasibility study"</p><p>http://www.biomedcentral.com/1472-6963/8/70</p><p>BMC Health Services Research 2008;8():70-70.</p><p>Published online 1 Apr 2008</p><p>PMCID:PMC2374784.</p><p></p

Waste cost proportion of "hot" drugs: 2005 vs 2006, first and second semester

<p><b>Copyright information:</b></p><p>Taken from "Drug waste minimisation and cost-containment in Medical Oncology: Two-year results of a feasibility study"</p><p>http://www.biomedcentral.com/1472-6963/8/70</p><p>BMC Health Services Research 2008;8():70-70.</p><p>Published online 1 Apr 2008</p><p>PMCID:PMC2374784.</p><p></p