Waste minimization and cost-saving strategies for drug use optimization in cancer chemotherapy: a scoping review

OBJECTIVES: The growing demand for anticancer drugs, increased drug wastage, and the chemotherapy cost are the major concerns in oncology care. The review aims to identify the various anticancer drug waste minimization strategies and the associated cost savings in hospital settings. METHODS: The five-stage approach of Arksey and O'Malley (2005) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines were used for the review. Keywords like "drug therapy," "chemotherapy," "cytotoxic drugs," "waste management," "waste reduction," "drug wastage," and "waste minimization" were used in PubMed, SCOPUS, and EMBASE databases for literature search. We used the two-step screening approach for the eligible articles, which were further cross-referenced and categorized based on the methods of waste minimization and cost savings. KEY FINDINGS: From the 3506 articles screened, 64 articles were identified as eligible for the review, and 12 were additionally included from cross-referencing. We identified 14 waste minimization strategies and 8 hospital programs/protocols in which dose rounding (25%), vial sharing (18.42%), closed system transfer device, or CSTD (10.53%), and drug reuse/recycling (10.53%) were the highest. All the studies showed waste reduction. Seventy two out of the 74 studies that used cost analysis showed cost savings as a reduction in the cost of wastage or overall economic savings. CONCLUSION: Though waste minimization strategies have been shown to have more significance on cost savings both for overall treatment and for the total cost of the drugs saved from wastage, conflicting results exist in the efficacy and cost-saving of some. These strategies in hospital settings require more attention.