Letters Overspending on cancer drug vials

The drug industry can help reduce cancer drug costs

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i1551 (Published 21 March 2016) Cite this as: BMJ 2016;352:i1551
  1. Peter J Gilbar, consultant pharmacist and senior lecturer1 2,
  2. Margot J Tannock, senior pharmacist1
  1. 1Cancer and Palliative Care Services, Toowoomba Hospital, Toowoomba, Qld 4350, Australia
  2. 2School of Medicine, University of Queensland, Qld, Australia
  1. peter.gilbar{at}health.qld.gov.au

Bach and colleagues’ article is particularly relevant because cancer drug expenditure is of major concern.1 Increasing the range of vial strengths is one way to contain spending. Unfortunately vial sharing is not always feasible. In Australia, many cancer centres outsource cancer drug manufacturing to accredited commercial suppliers, who, for high usage items, charge on a per milligram basis rather than per vial, thus enabling serious cost savings.

Other strategies to reduce expenditure are available to the drug industry.2 To ensure patients receive the full prescribed drug dose, vials must contain some excess. Drugs including azacitidine, bleomycin, bortezomib, cisplatin, dacarbazine, and epirubicin have been reported to contain insufficient excess.2 Owing to technical problems during reconstitution, it is difficult to withdraw the entire vial contents, necessitating the use of another vial. Forcing manufacturers to provide overage in vials (say 5%) solves this problem.

Once prepared for administration, lack of reliable stability data means that many cancer drugs have very short expiry times. If drugs are pre-made or pre-purchased and treatment is delayed or cancelled, they may be wasted. Surely a small proportion of the millions of dollars invested in research and development by the drug industry could be used on studies to extend drug stability.

Increasing drug vial strengths and other strategies have the potential to save large amounts of money. Government agencies, such as the US Food and Drug Administration, should ensure that the drug industry complies with these simple initiatives before granting drug approval.



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