Feasibility analysis of dose banding for oncologic preparations in a medium-sized hospital

Objectives To assess the feasibility of implementing dose banding for intravenous oncologic preparations in a medium-sized hospital, quantifying the proportion of individualised doses that could be covered by predefined bands, the dose deviations and the proportion of doses that would be discarded. Methods A simulation study was performed using all oncologic intravenous preparations compounded for the oncology day-care clinic during 2023 in a 485-bed hospital. Drugs were eligible if they were prescribed at individualised doses, had post-compounding stability of at least 14 days and exceeded 300 preparations per year. Logarithmic dose bands were constructed for each drug using two target coverage scenarios (60% and 80% of preparations) and three band configurations (five, four and three bands). Scenarios were accepted only when all band-related deviations from the individualised dose remained within ±5%. Weekly demand was simulated over 52 weeks to estimate required stock and expiry-related discard. Results Of 43 oncologic drug presentations compounded in 2023, four met the predefined criteria for dose banding analysis: bevacizumab, irinotecan, paclitaxel and trastuzumab. In the five-band, 60% target scenario, acceptable dose banding was feasible for all four drugs, covering 61.4% of bevacizumab, 59.0% of irinotecan, 71.2% of paclitaxel and 62.1% of trastuzumab preparations. In the five-band, 80% target scenario, only paclitaxel and trastuzumab remained feasible, covering 79.0% and 79.8% of preparations, respectively. Four-band and three-band scenarios reduced feasibility further. Estimated discard remained below 10% for bevacizumab, irinotecan and trastuzumab in feasible simulations, but ranged from 10.9% to 23.8% for paclitaxel. Conclusions In this medium-sized hospital, dose banding was feasible only for a limited number of stable, high-volume antineoplastic drugs and remained highly dependent on the drug selected and the band configuration used. These findings support a selective, locally tailored approach to dose banding rather than routine implementation across all eligible oncology preparations.