Analysis of non-administered chemotherapy preparations (NCPs) : an update on a 5-year experience

Introduction
The organization implemented in our establishment often leads to medical and pharmaceutical validation before incoming patient in chemotherapy day unit. The limit value of 1% of non-administered chemotherapy preparations (NCPs) is usually mentioned as a threshold reference. The aim of this study was to rate the quantitative and economic evolution, and to analyse the different reasons of non-administration over a 5-year period.

Methods
CHIMIO^® software registers each chemotherapy preparation. At the same time, every NCP is prospectively collected in an EXCEL^® file since 2014, mentioning: the drug, the dose, the cost of the preparation, the reason for non-administration and if relevant, the reallocation of the preparation. The cost assessment of the NCPs is based on the price per milligram of drugs. The medical records and CHIMIO^® software (in which reasons of non-administration are sometimes mentioned) enable to analyse the reasons for non-administration.

Results
In 2019, 24,042 chemotherapies were prepared, namely an increase of approximately 12% since 2015. As well, 354 chemotherapies were non-administered in 2019, which is an 80% increase compared to 2015. Among these NCPs, 89% (315/354) could not be reassigned and were not administered, that is an increase of 65% compared to 2015. The non-reallocated and NCPs rate reported to the global activity, increased by 0.42% since 2015 and represented 1.31% of all the annually prepared chemotherapies in 2019, with an average increase of 0.10% per year. The cost of the NCPs increased by 241% and reached 149,286 € in 2019. This increase is mainly related to the growing prescription of immunotherapies, produced by anticipation for some of them (ex: nivolumab, pembrolizumab). However, these preparations are systematically reallocated. The number of reallocated NCPs were 10 times higher in 2019 and contributed to mitigate financial loss by 79,688 €. Thus, the overall cost of NCPs reached 69.598 € (+80% compared to 2015). The main reasons for non-administration were similar over the 5-year period: clinical or biological disorders (43 %), prescription changes after “OK Chimio” (37%).

Discussion-Conclusion
These results will be introduced to the care units for reflection about areas of improvement to fall below this threshold value of NCPs (1%) (Biological/clinical disorders, absent patients, and prescription changes) These proposals consist, for example, to call the patient the day before to confirm the appointment. A 2nd “OK Chimio”, post medical consultation, is already required for expensive drugs, and the extension of this practice will be discussed. The effectiveness of these corrective actions will be assessed by internal audits.

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