Dutch survey finds redispensing cancer pills can save millions

Re-issuing a cancer patient’s unused medication to a fellow patient can save up to €50 million annually in the Netherlands, a study conducted at four Dutch hospitals and published in JAMA Oncology has found. However, the EU-wide Falsified Medicines Directive is preventing a wider roll-out of this environment- and cost-friendly programme.

Lisa-Marie Smale, a pharmacist and PhD candidate at the Radboud University Medical Centre, investigated with her colleagues whether unused drugs to treat cancer could be collected, checked for quality, and reissued to a different patient to cut down on waste, save money, and also benefit the environment.

Such drugs, the researchers found, were usually returned due to disease progression, toxic effects, changes in medication or dosage, or discontinuation of treatment.

The study involved 1,071 patients and a total of 13,069 oral anticancer drugs (OADs) were dispensed. In two years, 171 patients returned 335 unused packages. After quality assurance, 228 packages were dispensed, reducing waste by 68%. Mean net annual cost savings were estimated to be €576 per participant.

Following the successful results, the study is being expanded to 14 hospitals. Smale estimates that the Netherlands could save between €20 and €50 million annually if the re-dispensing programme was to be rolled out nationwide. She expects that even more money could be saved in the US where the price of new drugs is over 300% higher.

“We were actually the world’s first re-dispensing programme in which we verified quality and we did that by using sealed packaging and time-temperature indicators,” Smale told Euractiv.

Pharmacy employees assessed the quality of the returned drugs using certain criteria. OADs that fulfilled all criteria were restocked and re-dispensed to participants who had a prescription for the same OAD. The quality control measures and manual labour had a mean annual operational cost of €37 per participant.

Cancer patients motivated to give back to society

While the state benefitted from saving costs, Smale wondered about what the incentive for patients to participate in such a programme could be.

“So we started with interviews with patients living with cancer to ask them about their willingness to participate. Personally, I felt a little bit heavy on the subject because I was like, these people are having a really severe disease and I’m going to ask them to do something to save costs,” she told Euractiv.

“But it turned out that these patients are so motivated because they’re really grateful for the treatment that they receive,” she explained.

With the costs for their expensive drugs covered by their insurance, the patients were motivated to give something back to the community.

The researchers are looking into expanding the programme to cover other types of medication. It is likely to be most effective for drugs pricier than €100 per package.

‘I hope companies don’t raise prices’

With states potentially buying fewer drugs, saving millions in the process, would drug manufacturers simply increase their costs to make up for lost profits?

“I hope not. I hope that they also feel an ethical responsibility. Because in the end, it’s better for everyone, also for pharmaceutical companies, if their medications provide a maximum therapeutic value. Medications that end up in the bin do not provide any therapeutic value at all,” Smale said.

Merit Boersma, a spokesperson for the Dutch Association of Innovative Medicines (VIG), told Euractiv pharmaceutical companies are in favour of reusing medicines. Companies make medicines to be used not to be discarded and discarded drugs mean that companies don’t get data for clinical trials that compare old drugs to newer ones, she said.

The sustainability programme manager at VIG, Annelies de Lange said that giving suitable medications to patients who use them and benefit from them raises a company’s standard.

“So other doctors would be more willing to prescribe your medicine because it has a higher rating as there are more people that have benefitted from it than not. In that circle you would end up selling more,” de Lange said.

Boersma and de Lange said that while this is currently a hypothetical model, it aligns with the direction the healthcare sector is heading in: value-based payments, whereby companies get paid if their medicines actually work, doctors prescribe medicines that help patients, and patients get the drugs they need.

Falsified Medicines Directive is the next hurdle

Progress to expand drug re-dispensing schemes is currently being hindered by the Falsified Medicines Directive (FMD), according to Smale. Her team created a video specifically for European policymakers to encourage them to join the discussions on reusing medicines that would otherwise go to waste.

Boersma said that if safety is a paramount consideration with all the right measures in place, one should not be too cautious and should give the idea of re-dispensing medications a try. The VIG has also published a white paper on the topic.

She added that outgoing Dutch Health Minister Ernst Kuipers (D66) is lobbying to introduce medicine reuse legislation in Europe.

[By Christoph Schwaiger – Edited by Vasiliki Angouridi/Zoran Radosavljevic | Euractiv.com]

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