METHODS
The study was conducted as a single-centre, cross-sectional,
observational study in the paediatric oncology day care unit of a
tertiary care hospital in India from November 2019 to May 2021. A sample
size of 100 patients was targeted based on published literature [4].
Ethical approval was obtained from the Institutional Ethics Committee
(IEC) with the IEC number IEC/381/19, and written informed consent and
assent were obtained from all participants before enrolling them in the
study.
The study included paediatric cancer patients (less than 18 years of
age) who were scheduled to receive parenteral chemotherapy drugs.
Patients whose chemotherapy details were recorded once were excluded
from the study. The details were recorded based on the information
obtained from the patient and their medical record. The information
recorded included the chemotherapy drug, dose (mg/m2), total calculated
dose, formulation details, actual drug consumed (mg), drug wasted (mg),
the total cost of the drug (INR), cost of the wasted drug (INR), and
measures taken to reduce drug wastage (if any), such as rounding off the
dose or sharing of the vial. All this information was recorded on a case
record form. The cost of one unit was obtained from the hospital
pharmacy, outside pharmacies, or NGOs. If provided by NGOs, the retail
price for that brand was noted by the pharmacy, and an expense
assessment was
conducted.
Our independent analysis of drug wastage included the following
scenarios: 1) Calculation of the unused dose by subtracting the
prescribed dose from the total amount of drug in the vial in mg; 2)
Estimation of the total cost of the drug in INR and the cost of the
wasted drug; 3) Determination of the frequency of sharing vial or
rounding off dose if applicable.
We also estimated whether the prescribed doses for different
chemotherapy drugs matched the vial size availability at our hospital
pharmacy and outside pharmacies as per CIMS 2022.
Statistical analysis : All collected data was entered into
Microsoft Excel 2016. Continuous variables were expressed as mean ±
standard deviation (SD), and categorical variables were expressed as
percentages and frequency. The percentage of drug wastage was determined
at a 95% confidence interval.
RESULTS
Our analysis included 100 patients who received 140 parenteral
chemotherapy drug administrations of 22 different drugs. The mean (±SD)
age of patients was 6.67 (±3.63) years, with a male predominance of 67
(67%) compared to females, who were 33 (33%).
Hematological malignancies were observed in 89% of our study population
(n=100) compared to solid tumors, which were observed in 11%
(Table 1 ).