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File this under ‘Waste not, want not.’

In response to the cost of medicines, a fierce debate has broken out in recent years over ways to reduce the amount of unused liquids left in vials of infused or injectable cancer treatments and other therapies. One widely cited estimate suggested the U.S. health care system wasted $2.8 billion each year.

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  • Bortezomib is a good example. Not only are a lot of patient small enough to deserve only a small portion of the vial, there are larger people who get a lower dose because they can’t tolerate a higher dose. There is a lot of waste here.

    One solution is to insist that there are multiple vial sizes, with the smaller vials costing less to purchase.

    Please don’t talk about fixed doses. That is a bad idea.

    It is very difficult to offer more advice. One last possibility is to liberalize scheduling. If the usual dose for a particularly large person is 1 and 1/4 vial weekly, 3 out of 4 weeks might one consider giving 1 vial weekly every week, about the same total dose. Or instead of 4/5’s of a vial daily for 5 days give a whole vial daily for 4 days. That sort of mentality would reduce wastage.

    None of this is particular motivating to oncologists. (we would make less money.) But it is the right thing…. How do we motivate?

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