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Pharmacists Support 10% Dose-Rounding of Anticancer Agents

February 19, 2018

By Will Boggs MD

NEW YORK (Reuters Health) - New recommendations from the Hematology/Oncology Pharmacy Association (HOPA) support dose-rounding of up to 10% for biologic and cytotoxic anticancer agents.

Rounding up drug doses to the nearest vial size can minimize drug waste, ensure accuracy during drug preparation, and reduce healthcare expenditures.

Dr. Rebecca Fahrenbruch from Fairview Pharmacy Services, in Minneapolis, Minnesota, and colleagues on a task force of oncology pharmacists assembled by the HOPA Standards Committee prepared a guideline intended for use during the development of a dose-rounding policy and to support and validate existing policies.

Based on published data, HOPA recommends that monoclonal antibodies and other biologic pharmaceutical agents should be dose-rounded to the nearest vial size within 10% of the prescribed dose, unless exempt per institutional dose-rounding policy.

Traditional cytotoxic agents should also be dose rounded within 10% of the prescribed dose, unless exempt.

Dose-rounding procedures applied to cytotoxic agents are recommended for monoclonal antibodies with a cytotoxic constituent, the authors write in the Journal of Oncology Practice, online February 5.

While some providers support dose-rounding within 10% for palliative therapy and within 5% for curative therapy, HOPA supports the same 10% threshold for dose-rounding of anticancer agents for both settings.

For patients prescribed oral chemotherapy, when there is more than one strength of capsule or tablet, HOPA recommends using one strength and rounding the final dose to avoid confusion for the patient and to eliminate the possibility of multiple copayments.

Finally, HOPA recommends that institutions develop policies for dose-rounding that include exceptions and special considerations for such contingencies as clinical trials and patient conditions that require close attention to exact dosing.

“Dose rounding represents a relatively simple cost-saving measure that institutions can implement to reduce waste and health care costs,” the authors conclude.

Dr. Mehmet Sitki Copur, medical director of oncology at St. Francis Cancer Treatment Center, in Grand Island, Nebraska, recently reviewed the potential cost savings realized by dose-rounding of monoclonal antibodies. He told Reuters Health by email, "Based on our published data as well as on this new publication by HOPA, dose-rounding of traditional and also newer biological antineoplastic drugs by 10% (unless exempted by institutional policies), is an acceptable practice. It would not influence safety and efficacy but would save cost in use of these very expensive drugs.”

“As I stated in our publication, in an era of unsustainable cancer care costs, oncology care providers are obliged to find ways to minimize waste without compromising efficacy,” said Dr. Copur, who was not involved in the new recommendations. “Not only is there an issue for effective dose finding of new biologics but waste can also be created . . . by packaging these expensive drugs in single use vials with short expiration time and in quantities much larger than the amount that would be needed.”

“We can hope that policy makers revisit the current guidelines and encourage the FDA, CDC, CMS, and US Pharmacopeial Convention to collaborate and come to a consensus on vial contents and vial sharing,” Dr. Copur said.

“Last but not least, with the recommendations by HOPA now, most oncology practices can adopt these guidelines by incorporating them into their electronic health record softwares with algorithm changes to automatically enable dose rounding and save time and cost,” he said.

Dr. Fahrenbruch did not respond to a request for comments.


J Oncol Pract 2018.

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