Economics of providing antineoplastic drugs in a manufacturer-mixed bulk package

The cost impact of converting from a hospital-mixed (HM) system for preparing antineoplastic-drug doses to a manufacturer-mixed bulk package (MMBP) system in a 565-bed comprehensive cancer center is analyzed. The cost per dose for nine antineoplastic agents--bleomycin, cisplatin, cyclophosphamide, doxorubicin, fluorouracil, methotrexate, mitomycin, vinblastine, and vincristine--was assessed for each system. The average dose for each drug was determined by reviewing nearly 2200 physician orders collected over nine days. Cost per dose was calculated by allocating the costs associated with the production of multiple-dose containers and withdrawal of a single dose. A time-and-motion study using standard industrial engineering methodology measured labor times for all tasks associated with the production of drug doses. Calculated costs included direct labor, drug expense, supply expense, drug waste, waste removal, overhead, management labor, and inventory reduction. Operating costs (labor, supplies, overhead, and waste and waste removal) were reduced by an average of 26% per dose for all drugs, using the MMBP system. This institution produces a high volume of antineoplastic admixtures; thus, the impact on operating costs is likely to be different in other institutions. The total measured operating and drug acquisition costs decreased for three drugs, marginally increased for five drugs, and increased substantially for one drug. Based on this institution's use of the nine antineoplastic agents, the total first-year savings from conversion from the HM system to the MMBP system would be $31,219, including a one-time inventory reduction of $94,621. However, in subsequent years, use of the MMBP system would result in increased costs of $63,402.(ABSTRACT TRUNCATED AT 250 WORDS)