INTRODUCTION
The incidence of childhood cancers in India is alarmingly high, with 75 to 150 childhood cancers per million children, comprising about 20% of all paediatric cancers worldwide.[1] As per GLOBOCAN 2020, India records one million new cancer diagnoses annually, of which 3% occur in children.[2] However, life-saving cancer treatments are expensive and can put a significant financial burden on families, leading to further disruptions in family dynamics. In India, patients bear almost 68% of their healthcare expenditure, which is much higher compared to the world average of 18% where the majority is under insurance coverage. Additionally, medicines account for 70% of the out-of-pocket expenditure on healthcare by individuals and families in India, making it a significant barrier to healthcare access, particularly for those with a lower socioeconomic status.[3]
As per current chemotherapy practices, the dosing of drugs is determined by several factors, including the type of cancer, stage, treatment protocol, weight or body surface area of the patient, age, comorbidities, and general health of the patient. Therefore, there may be variations in chemotherapy drug doses among patients using the same protocol for the treatment of the same cancer [4]. However, most chemotherapy formulations are available as single-dose packages, which can lead to drug wastage if the amount of drug required does not match the amount of the drug in the vial. This is mainly caused by administering chemotherapy drugs from vials containing larger amounts than required and not using the remaining portion of the vial, leading to drug wastage. This contributes to the increasing overall burden of cancer care[5]. However, limited vial size options and drug stability can restrict the potential of vial sharing between patients.
According to studies conducted by Gopi Shankar et al., 2019 [6] and Truong et al., 2017 [7], drug wastage and its economic implications significantly add to the cost of cancer care without providing any incremental value to patients. Research in this field has suggested options such as vial sharing, rounding of doses, and batching of patients as per pathology to curb wastage and decrease costs [8].
Most studies on drug wastage for chemotherapy drugs have focused on their use in adult oncology care. Hence, this study aimed to estimate drug wastage specifically in the treatment of paediatric malignancies at our hospital. Additionally, the economic impact of this wastage was estimated, and existing measures (if any) for decreasing drug wastage were noted.