Robot Pharmoduct® of Dedalus : Feasibility study of the implementation of automated campaigns of chemotherapy preparations.

E. Monfort, S. Molignier, T. Lombard, S. Lançon, I. Princet Pharmacy, CHU of Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France

Introduction
In a context of constant increase in the production activity of chemotherapy, with fixed human means, we have acquired a robot to improve productivity. To facilitate early production, standard doses for 19 molecules have been implemented.

Objective
Evaluate the feasibility of automated campaigns for the 19 molecules.

Equipment and method
A tool has been developed to assess the robot’s production capacities by integrating its own constraints such as a maximum production capacity of 14 chemotherapy bags, product vial positions limited to 15 and a product loss of 9 ml per campaign. This tool allowed us to determine for each molecule and each standard dose the maximum achievable number of preparations per campaign and the associated additional production costs. Then, we have established a monthly forecast of the number of campaigns to be carried out, considering the consumption data and the stability of each product.

Results
Overall, we have evaluated the automated production of 69 standard doses. The maximum number of chemotherapy bags prepared by the robot was on average 11 [3-14] per campaign. Limiting factors were the number of product vials and the volume of the multi-dose-bag equal to 1L. The number of campaigns required to cover 1 month of production was estimated to 123, meaning 6 campaigns per day. The monthly additional cost due to principle losses has been estimated at 47280 euros, 98% of this cost is allocated to 5 molecules : Bevacizumab, Nivolumab, Pembrolizumab, Rituximab and Trastuzumab.

Discussion
This feasibility study allowed us to refine our strategy for the automated production of chemotherapy. The 5 most expensive molecules will remain manually produced under insulator to limit product losses during preparation. In order to optimize the robot productivity , a 2L multi-dose-bag creation has been requested. Also, for less-consumed molecules we choose to adapt the length of series to the consumption in order to limit losses due to finished products destruction, and to combine the production of several standard doses within the same campaign when possible, to optimize the robot loading. At last, the tool developed for this study will facilitate the planning of the automated production campaigns by calculating raw material requirements for each campaign according to the series length.

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