Contribution of dose harmonization to the reallocation of preparations

Introduction
Chemotherapy activity in our hospital continues to increase due to a growing number of new patients and to the need to subcontract preparations for other establishments within our Territory Hospital Group : 12,000 preparations are forecast for the year, compared to 10,000 in 2023. To cope with this, it will be necessary to develop advance preparation, which is likely to increase the proportion of returned preparations for non-administration. The challenge here is to harmonize doses in order to encourage their reallocation.

Material and method
The data were extracted for the year 2023 from the CHIMIO^® software. The eligibility criteria for the molecules were : high prescription rate (>300) and wide dispersion of prescribed doses (>10). For each molecule, graphs of « prescription frequency per dose » were created. This identified the most commonly prescribed doses and dose intervals, which had to be covered by the harmonized doses in order to be relevant. Based on the experience of other establishments, the range of each harmonized dose was set at +/- 5%.

Results
Nine molecules are eligible : paclitaxel, 5-FU in diffuser form, carboplatin, gemcitabine, bevacizumab, etoposide, irinotecan, oxaliplatin and levofolinate. For each eligible molecule, the proposed harmonization will make it possible to divide the number of doses to be prescribed by 2 to 6, while covering between 83% and 96% of prescriptions.
Example of paclitaxel: identification of a main dose range between 100 and 150 mg. We have proposed 4 standard doses (105, 120, 135, 150 mg) that cover 92% of prescriptions, against 13 doses used up to now. This increases the probability of reallocation.

Discussion and conclusion
A simulation showed that 64% of the destroyed preparations in 2023 could have been reallocated, (that is to say 57 preparations/89 destroyed), taking their stability into account, if the proposed harmonized doses had been effective. Considering these encouraging results, the harmonization of doses will make it easier to reallocate unadministered preparations. The preparation reallocation circuit has been worked on again to comply with the 2023 Good Manufacturing Practices. These results have been used as a means of communication and awareness-raising tool for prescribers that enable them to support the approach.

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