Optimal analysis of the supply of some cancer drugs preparation by dosage at Choray Hospital

o investigate the list of cancer drugs with the highest rate of dividing dose in preparation of cancer drugs by individualized doses at Choray Hospital in year of 2015; to analyze the optimal supply of some typical cancer drugs in drug preparation.

OPTIMAL ANALYSIS OF THE SUPPLY OF SOME CANCER DRUGS

PREPARATION BY DOSAGE AT CHORAY HOSPITAL

Nguyen Van Tung 1 ; Nguyen Quoc Binh 2

Nguyen Truong Son 2 ; Nguyen Thi Thu Thuy 3

SUMMARY

Objectives: To investigate the list of cancer drugs with the highest rate of dividing dose

in preparation of cancer drugs by individualized doses at Choray Hospital in year of 2015;

to analyze the optimal supply of some typical cancer drugs in drug preparation Method: Cross-sectional description based on retrospective data of cancer drugs at Choray Hospital in the year

of 2015 Data were processed by Microsoft Excel 2010 Results were presented in figures and tables Results: Top 10 active ingredients with the highest rate of dividing dose in 2015: Cytarabine had the highest rate (92.5%), followed by etoposide (76%), epirubicin and cisplatin (61%), doxorubicin (52%) The remaining active ingredients (oxaliplatin, carboplatin, pemetrexed, gemcitabine) had a lower percentage and ranged from 20% to 50% Oxaliplatin had preparation concentration ranged from 10 to 420 mg in different preparation rates Most of them had the preparation rate under 1%, preparation concentration of 200 mg had the highest rate (26.5%), followed by 150 mg (18.0%), 100 mg (10.9%), the remaining preparation concentrations were below 10% Doxorubicin had preparation concentration ranged from 5 to

100 mg, most of which had the preparation rate less than 10% The concentration of 50 mg had the highest rate (18.6%), followed by 70 mg (15.8%), 60 mg (12.9%) and concentrations with very low rate were 5 mg, 17 mg, 18 mg and 45 mg (less than 2%) Conclusion: Optimal analysis of the supply of some drugs showed that 3,842 preparations of oxaliplatin and 653 preparation of doxorubicin were inappropriate Appropriate distribution for each concentration saves 6.96 billion VND in oxaliplatin and 2.07 billion in doxorubicin

* Keywords: Cancer drug preparation; Individual dosage; Dividing dose

INTRODUCTION

Individualized dosage preparation (IDP)

has been proven to bring optimum efficacy

at a lower cost than nomal preparation [1, 2]

which are available in many countries

around the world, particularly in the use of

cancer drugs [4, 5] Since 2012, Vietnam

has officially applied the IDP on patients

with the pioneer hospital is Choray Hospital [3] In IDP, dividing dose is regularly made

to save the cost of drug use This leads to the need of considering the supply of drugs, especially for drugs with different concentrations at different prices and in different ways of dividing Therefore, sufficient and reasonable supply of drugs in differrent concentrations needs to optimize the dividing

1 Vietnam Military Medical University

2 Choray Hospital

3 University of Medicine and Pharmacy, Hochiminh City

Corresponding author: Nguyen Van Tung (trangtungtruc@gmail.com)

Date received: 31/07/20181

Date accepted: 24/09/2018

dose and cost of drug use Thus, a study

to optimize the percentage of each

concentration among the packaged drug

supplying for IDP would be a suggestion

for the rationalized drug list in the hospital

So the study "Optimal analysis of the supply

of some cancer drugs preparation by dosage

at Choray Hospital" was conducted.

SUBJECTS AND METHODS

1 Subjects

Reserved data on concentrated preparation in 2015 at Choray Hospital (trade names of drugs, number of dispensaries, number of split, unit price )

2 Methods

Study design: Cross-sectional description based on retrospective data of cancer drugs at Choray Hospital in the year of 2015

Data processing: Data were processed by Microsoft Excel 2010, results were

presented in figures and tables

RESULTS AND DISCUSSION

1 Investigate the list of cancer drugs with the highest rate of dividing dose in preparation of cancer drugs by individualized doses at Choray Hospital in 2015

* The list of cancer drugs had a high rate of dividing dose:

A list of 4 high-dividing-dose cancer drug groups (alkylated, anti-tumor antibiotics,

anti-metabolism and topoisomerase inhibitors) was presented in table 1

Table 1: List of drugs from 4 groups with high rate of dividing dose by 2015

Drug group Active

ingredient

Concentration/

dose

Number of preparation

Number of dividing dose

Percent (%)

Usage value (VND)

Topoisomerase

inhibitors

Anti-metabolism

Anti-tumor

antibiotics

Doxorubicine

10 mg/5 mL

20 mg/10 mL

50 mg/25 mL

Epirubicin

50 mg

10 mg/5 mL

50 mg/5 mL

50 mg/25 mL

Alkylated

Cisplatin

10 mg/10 mL

10 mg/20 mL

50 mg/50 mL

Cyclophosph a-mide

200 mg,

Oxaliplatin

50 mg/10 mL

100 mg/20 mL

200 mg/40 mL

According to table 1, four groups of

drugs with high rate of dividing dose

consisted of 22 active ingredients Among

them, the alkylated group had the highest

number of active ingredients (9), followed

by the anti-tumor group (6 active ingredients),

anti-metabolism (5 active ingredients) and

topoisomerase inhibitor (2 active ingredients)

Drugs in the list had a percentage ranging

from 0% to 92.5%, with the highest rate

from cytarabine in the anti-metabolism

antibiotics (92.5%) Some ingredients did not

divided included: fludarabine, idarubicin,

farmorubicin, carmustine, melphalan

The highest number of dividing dose

times was oxaliplatin (2968), 26 times

higher than the lowest 5-fluorouracil (114)

The remaining active ingredients which had high proportion in dividing dose included cisplatin, carboplatin, gemcitabine, doxorubicine, etoposid, epirubicin, cytarabine and cyclophosphamide

* Top 10 active ingredients had the highest percentage of dividing dose:

Survey on the top 10 active ingredients with the highest rate of dividing dose in

2015, the result indicated that: Cytarabine had the highest rate (92.5%), followed by etoposide (76%), epirubicin and cisplatin (61%), doxorubicin (52%) The remaining active ingredients (oxaliplatin, carboplatin, pemetrexed, gemcitabine) had a lower percentage and ranged from 20% to 50%

* Top 10 active ingredients had the

highest cost of drug use:

Survey on the top 10 active substances

with the highest cost of drug use in 2015,

the following results were obtained:

Oxaliplatin had the highest cost (over

27 billion VND), followed by irinotecan

(6.15 billion VND), pemetrexed (5.7 billion

VND) and gemcitabine (3.4 billion VND)

The remaining active ingredients ranged

from 0.9 to 2.7 billion VND including

ifosfamide, ebirubicin, ciplastin,

methotrexate, carboplatin and doxorubicine

2 Analyze the optimal supply of

some typical cancer drugs in drug

preparation

In the list of drugs with high rate of

dividing dose and the high cost of drug use,

some drugs appeared in both categories

included oxaliplatin, pemetrexed, gemcitabine, doxorubicin, carboplatin, epirubicine and cisplatin For optimal analysis of the quantity supplied in drug preparation, the study selected two typical drugs including oxaliplatin (the highest cost, average percentage and four different concentrations); doxorubicin (the fifth highest cost, average percentage and three different concentrations)

- Optimal analysis of the supply of oxaliplatin:

+ The status of the preparation of oxaliplatin in 2015:

Investigate the status of the preparation

of oxaliplatin based on preparation concentration and preparation rate in each concentration in 2015, the results were presented in figure 1

Figure 1: Status of the preparation of oxaliplatin in 2015

According to figure 1, oxaliplatin had preparation concentration ranged from 10 to

420 mg in different preparation rates Most of them had the preparation rate under 1%, preparation concentration of 200 mg had the highest rate (26.5%), followed by 150 mg (18.0%), 100 mg (10.9%), the remaining preparation concentrations were below 10%

+ Reckon up the unreasonable preparation of oxaliplatin:

More detailed investigations were conducted in each preparation of oxaliplatin, the study recorded many cases of unreasonable preparation such as the use of small doses for multiple doses (50 mg dose used to prepare a concentration of 210 mg),

or use a high concentration to prepare a small dose (200 mg dose to prepare 120 mg)

or use a small concentration to a large concentration already available (50 mg dose used for concentration phase 150 mg) This unreasonable preparation can be traced back to the lack of essential ingredients in the preparation process The use of unreasonable concentrations at various costs can increase the cost of drug use Sum up unreasonable preparations in 2015 and provide new preparation methods based on the reduction of unit price per preparation, results were presented in table 2

Table 2: Status of the preparation of oxaliplatin in 2015 and optimal methods

proposed in preparation

Concen-

tration Dose

Prepara

tion concent

ration

Number

of prepara tion

Unit price/

preparation (VND)

Cost (VND) Concentr

ation Dose

Preparat ion concentr ation

Number

of prepara tion

Unit price/

preparatio

n (VND)

Cost (VND)

100 2 200 1,003 4,607,908 4,621,731,660 200 1.00 200 1003 4,200,000 4,212,600,000

150 1.33 199.5 317 7,554,400 2,394,744,800 150 1.33 200 317 7,554,400 2,394,744,800

According to table 2, in 2015, oxaliplatin had 3,842 unreasonable preparations among 6,192 total preparations, concentration of 50 mg had the highest number (1,769 times), followed by the concentration of 100 mg (1,003), 150 mg (963) and the lowest was 200 mg (107) The total cost of these unreasonable preparations was about

21 billion VND, after the redistribution of the dosage and the reasonable concentration based on the reduction of unit cost/preparation, total cost was 14.04 billion Thus, oxaliplatin preparation using appropriate concentration helped to save 6.96 billion VN

115

+ Optimal supply of oxaliplatin:

Based on the current status of drug preparation in 2015, the study results of the optimal

analysis on supplying of oxaliplatin by each concentration were presented in table 3

Table 3: Optimal supplying number of oxaliplatin by each concentration

Concentration

(mg)

Total preparation concentration (mg)

Order quantity (bottle)

Order percentage (%)

As shown in table 3, with the different total preparation concentration of each

concentration in 2015, the number of orders of oxaliplatin in 2015 should be: 100 mg

with 5,432 bottles (accounted for 68.08%), followed by 200 mg with 1,977 bottles (24.78%)

50 mg and 150 mg had lower order quantities with 337 bottles (4.22%) and 232 bottles

(2.91%), respectively

- Optimal analysis on the supply of doxorubicin:

+ The status of the preparation of doxorubicin in 2015:

Investigate the status of doxorubicin preparation according to the preparation

concentration and preparation rate in each concentration in 2015, the results were

presented in figure 2

Figure 2: Status of doxorubicin preparation in 2015

As shown in figure 2, doxorubicin had preparation concentration ranged from 5 mg

to 100 mg Most of them had the preparation rate less than 10%, the concentration of

50 mg had the highest rate (18.6%), followed by 70 mg (15.8%), 60 mg (12.9%) and

concentrations with very low rate were 5 mg, 17 mg, 18 mg and 45 mg (less than 2%)

+ Reckon up the unreasonable preparation of doxorubicin:

A more detailed investigation of each preparation time of doxorubicin has found that many of the unsuitable preparation are similar to those of oxaliplatin Sum up unreasonable preparation in 2015 and propose new preparation plans based on the

reduction of unit cost per preparation, the results were presented in table 4

Table 4: The status of doxarubicin preparation in 2015 and optimal methods in

preparation proposed

Preparat-ion concentr

ation

Number

of prepara-tion

Unit price/

preparation (VND)

Prepara- tion concent-ration

Number

of prepar-ation

Unit price/

preparation (VND)

Cost (VND)

According to table 4, in 2015 doxorubicin had 653 unreasonable preparations among 1,939 preparations, the concentration of 10 mg had the highest unreasonable number of preparations (407 times), followed by 20 mg (246) and 50 mg had no unreasonable preparation The total cost of these preparations was about 2.2 billion VND After the redistribution of the dosage and the reasonable concentration based on the reduction

of unit cost per preparation, the total cost was 185.6 million VND Thus, doxorubicin preparation using appropriate concentration helped to save 2.07 billion VND

117

+ Optimal supply of doxorubicin:

Based on the current status of drug preparation in 2015, the study results of the optimal analysis on supplying of doxorubicin by each concentration were presented in table 5

Table 5: Optimal supplying number of doxorubicin by each concentration

Concentration

(mg)

Total preparation concentration (mg)

Order quantity (bottle)

Order percentage (%)

According to table 5, with the total preparation concentration of each concentration

in 2015, the optimal quantity supply of doxorubicin in 2015 should be: 50 mg with 2,073 bottles (accounting for 95.91%), followed by 10 mg with 89 bottles (4.09%) With a unit cost/preparation of 20 mg much higher than 50 mg, the study noted that it would be more cost-effective to use a 50 mg bottle to divide the dose Therefore, don’t need to order the concentration of 20 mg

CONCLUSION

In 2015, the four drug classes with the

highest dividing rates include alkylated;

anti-tumor antibiotic, topoisomerase inhibitor

and anti-metabolism group Of the 22 active

ingredients from four groups of drug, the

alkylated group had the highest number of

active ingredients (9) Active ingredients

that are both high in dividing rate and in

total cost were: Oxaliplatin, pemetrexed,

gemcitabine, doxorubicin, carboplatin,

epirubicine, cisplatin Optimal analysis of

the supply of some drugs showed that

3,842 preparations of oxaliplatin and

653 preparation of doxorubicin were

inappropriate Reasonable distribution for

each concentration saved 6.96 billion

VND in oxaliplatin and 2.07 billion in

doxorubicin Optimal suppling number in

2015 of oxaliplatin and doxorubicin were

as followed: 100 mg oxaliplatin (68.08%),

oxaliplatin 200 mg (24.78%), oxaliplatin

50 mg (4.22%), oxaliplatin 150 mg (2.91%);

doxorubicin 50 mg (95.91%), doxorubicin

10 mg (4.09%) and doxorubicin 20 mg (0%)

This will help guide the development of the

drug portfolio at a more reasonable rate

between pack sizes for the following year

(assuming that the patient morbidity and disease patterns are constant for most of the time)

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