Quantity and economic value of unused oral cancer drugs among patients who discontinue their therapy

Abstract

Setting and Method: At least one-third of patients using oral cancer drugs (OCD) discontinue their therapy early due to a lack of efficacy, adverse events or high out-of-pocket costs. Therapy discontinuation may lead to medication waste if the patient has not used all dispensed medication. Insight into the waste of OCDs could provide guidance for the development of waste-minimizing strategies. The objective of this study was therefore to determine the proportion of patients who have unused OCDs after therapy discontinuation, the reasons thereof, and the quantity and economic value of these unused medications. A retrospective follow-up study was conducted using a Dutch outpatient pharmacy database. Patients (C 18 years) who did not refill an OCD prescription, which was dispensed between November 2015 and February 2016, were contacted by phone and asked about their unused medication. The economic value was calculated using Dutch medication prices. Data were descriptively analysed in STATA13. Main outcome measures: The proportion of patients with unused OCDs after therapy discontinuation, their reason for discontinuation, and the quantity of packages that remained unused, including the economic value. Results: The database included 605 patients, of whom 90 patients likely had discontinued therapy and were contacted. Of these, 42 were excluded (18 had refilled their medication, 23 could not be contacted, 1 other). Of the 48 patients who had discontinued therapy (mean age 62.6 (SD -13.0) years, 52.1% female), 22 (45.8%) patients had unused medications. Patients primarily discontinued therapy early due to adverse effects (43.5%), followed by therapy changed (17.4%) and insufficient effect (17.4%). A total of 31 packages remained unused, with a median value of 179 (IQR 24-2487), amounting to a total of 34.500. Most patients kept the unused medications at home (60.9%) or returned them to the pharmacy (26.1%). Conclusion: Almost half of patients who discontinue OCD therapies have unused medications. The majority of patients do not dispose of their unused medications. Pharmacist interventions are needed to reduce the waste of expensive cancer therapies and to educate patients about safe disposal of unused medications.