Feasibility of an Individualized Dispensing Program for Patients Prescribed Oral Anticancer Drugs to Prevent Waste.

Abstract

Waste of oral anticancer drugs (OACDs) causes financial and environmental burdens. This study evaluates the feasibility of an individualized dispensing program to prevent waste of OACDs. Adult patients were dispensed individualized quantities of niraparib, abiraterone, enzalutamide, ruxolitinib, osimertinib, or imatinib as standard care, during the first 6 months of treatment. The first 50 patients participated in an feasibility evaluation conform five domains of Bowen's Framework. (1) <i>implementation</i>: reach (eligible patients included) and protocol fidelity (executions following protocol) assessed from pharmacy data, (2) <i>acceptability</i>: rated from 1 to 10 and agreement with theoretical framework acceptability domains via a survey among patients and pharmacy technicians, (3) <i>practicality</i>: program's costs, (4) <i>effect</i>: compared with previous practice (full package supply per month), defined as difference in unused OACD unit doses and net cost-savings, and (5) <i>demand</i>: potential scale-up of the program by including more OACDs. Participants' median age was 67 (interquartile range [IQR], 58-71) years, and 76% was male. (1) <i>Implementation</i>: reach and protocol fidelity were 89% and 90%, respectively. (2) <i>Acceptability</i> was high among patients (median, 9; IQR, 8-9) and pharmacy technicians (median, 7; IQR, 6-8). All acceptability domains were agreed on. (3) <i>Practicality</i>: program costs were €4,289. (4) <i>Effect</i>: unused OACD unit doses were reduced by 34%, causing net cost-savings of €693 per discontinued patient. (5) <i>Demand</i>: the program could be scaled up to seven times by including all OACDs. Individualized dispensing for patients prescribed OACDs is feasible for preventing waste in terms of implementation, acceptability, practicality, effect, and demand.