Reallocation of Chemotherapy Preparations: When Economics Meets Ecology

Introduction
To optimize chemotherapy workflows, preparations are validated and compounded before patient arrival. When treatment is not administered, preparation are returned to the pharmacy and may be reallocated, provided that stability, storage, and dose suitability requirements are met. While the financial and organizational benefits of this process are well recognized, its environmental impact has rarely been assessed. The aim of this study is to evaluate the overall economic and environmental impact of the chemotherapy reallocation process.

Methods
A single-centre retrospective study was conducted over five years (2021-2025). The numbers of returned, reallocated, and discarded chemotherapy preparations were collected
Economic impact was assessed by considering the cost per milligram of active pharmaceutical ingredient (API), consumables, and staff resources. Disposal costs associated with returned but non-reallocated preparations were estimated using infectious healthcare waste management costs.
Carbon impact was expressed as kilograms of CO₂ equivalent (kg CO₂e) and calculated by combining emissions associated with each milligram of API (Ecovamed^® database) and emissions related to infectious healthcare waste incineration.

Results
A total of 2,185 chemotherapy preparations were returned, of which 917 were successfully reallocated (42%). The most frequently returned drugs were fluorouracil (18%), paclitaxel (15%), oxaliplatin (11%), carboplatin (9%), and irinotecan (7%).
The total value of returned preparations amounted to €791,867. Reallocation enabled the recovery of €520,838, corresponding to 66% of the total value of returned preparations.
Returned preparations generated 48,614 kg CO₂e, equivalent to 23.6 Paris-New York round trips. Reallocation avoided 13,110 kg CO₂e, corresponding to 6.36 Paris-New York round trips.
Beyond the most frequently returned drugs, several high-carbon-impact medicines substantially contributed to the overall environmental burden, including methotrexate, mesna, and monoclonal antibodies.

Discussion
Reallocation of chemotherapy preparations generates substantial cost savings while reducing environmental impact, primarily driven by drug-related emission factors and waste incineration. Further improvements could be achieved through optimization of prescribing software and reduction of treatment cancellations through better coordination with clinical departments.
In addition to its economic and environmental benefits, reallocation may reduce patient waiting times and improve staff satisfaction by maximizing the value of work already performed.

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