Cost of implementing Veterans Administration directives for handling antineoplastic agents

Directives issued by the Veterans Administration central office for the safe handling of antineoplastic agents are described, and the costs associated with implementing these directives are reported. The directives are similar to other recent guidelines, including those issued by the Occupational Safety and Health Administration. Inventory records for a 12-month period were analyzed to determine the total number of doses of antineoplastic agents prepared and the total number of treatments administered at a 704-bed VA facility with a comprehensive cancer treatment program. For 3112 prepared doses and 2345 treatment regimens, the total cost of implementing the directives was $57,115, including $6,670 for the purchase of a vertical laminar-airflow hood. The VA central office directives represent reasonable guidelines for controlling the potential hazards of handling antineoplastic agents. Considerable expense is associated with implementing the directives; the degree of added expense will vary based on the particular hospital setting, the number of doses of antineoplastic agents administered, and the nature of the oncology services already in place.