OBJECTIVES: NHS England's Specialized Commissioning spends approximately £1.4 billion annually on chemotherapy treatment, with 80% attributed to drug acquisition costs. Breast cancer is the UK's most prevalent cancer, accounting for 15% of new cases, equating to roughly 56,000 cases each year. Chemotherapy is a common treatment for many cancer patients, requiring tailored dosing regimens. As infusion is the administration method for many chemotherapies, patients' doses are formed by combining multiple vials to achieve the precise amount needed, resulting in unused material that is wasted. This study aims to estimate and quantify this waste in relation to NHS England's annual drug acquisitions.

METHODS: Acquisition data from the secondary care medicines database (SCMD) was extracted for chemotherapy treatments considered in NICE appraisals for breast cancer between 2015 and 2021. Weight or body surface area (BSA)-dependent treatments were examined. Using NHS dose banding guidelines, the probability of individual dose bands was calculated based on weight/BSA distribution and the optimal vial usage, and subsequent waste, was calculated. These findings were then scaled to match the respective drug acquisitions, assessing the overall waste in £/year.

RESULTS: Waste percentages relative to acquisitions varied from 0% to 22%, with the highest waste cost amounting to £2.2 million for individual drug. Treatments with varying vial sizes exhibited lower overall waste compared to single-sized vials, and in certain cases, dose banding supported precise dosing for all patients, completely removing this source of waste.

CONCLUSIONS: The study concludes that using variable vial sizes, combined with carefully calculated dose banding, can help reduce waste. However, the analysis did not account for other potential sources of waste, such as suspended treatments, adherence issues, and vial availability. Additionally, while vial sharing may be a way to reduce waste, its practical implementation has not been well-established in clinical practice.