INTRODUCTION
The incidence of childhood cancers in India is alarmingly high, with 75
to 150 childhood cancers per million children, comprising about 20% of
all paediatric cancers worldwide.[1] As per GLOBOCAN 2020, India
records one million new cancer diagnoses annually, of which 3% occur in
children.[2] However, life-saving cancer treatments are expensive
and can put a significant financial burden on families, leading to
further disruptions in family dynamics. In India, patients bear almost
68% of their healthcare expenditure, which is much higher compared to
the world average of 18% where the majority is under insurance
coverage. Additionally, medicines account for 70% of the out-of-pocket
expenditure on healthcare by individuals and families in India, making
it a significant barrier to healthcare access, particularly for those
with a lower socioeconomic status.[3]
As per current chemotherapy practices, the dosing of drugs is determined
by several factors, including the type of cancer, stage, treatment
protocol, weight or body surface area of the patient, age,
comorbidities, and general health of the patient. Therefore, there may
be variations in chemotherapy drug doses among patients using the same
protocol for the treatment of the same cancer [4]. However, most
chemotherapy formulations are available as single-dose packages, which
can lead to drug wastage if the amount of drug required does not match
the amount of the drug in the vial. This is mainly caused by
administering chemotherapy drugs from vials containing larger amounts
than required and not using the remaining portion of the vial, leading
to drug wastage. This contributes to the increasing overall burden of
cancer care[5]. However, limited vial size options and drug
stability can restrict the potential of vial sharing between patients.
According to studies conducted by Gopi Shankar et al., 2019 [6] and
Truong et al., 2017 [7], drug wastage and its economic implications
significantly add to the cost of cancer care without providing any
incremental value to patients. Research in this field has suggested
options such as vial sharing, rounding of doses, and batching of
patients as per pathology to curb wastage and decrease costs [8].
Most studies on drug wastage for chemotherapy drugs have focused on
their use in adult oncology care. Hence, this study aimed to estimate
drug wastage specifically in the treatment of paediatric malignancies at
our hospital. Additionally, the economic impact of this wastage was
estimated, and existing measures (if any) for decreasing drug wastage
were noted.