Background: Dose banding is a system where doses that fall within defined ranges are rounded up or down to pre-determined “banded” doses with the maximum variation set at +/-6% for cytotoxic chemotherapy and +/-10% for MABs. This is already an established practice in the United Kingdom so we implemented the NHS dose banding tables, being one of the first hospitals in Australia to do so.
Aim: To examine the financial impact of dose banding implementation in an Australian hospital.
Method: Three chemotherapy drugs (paclitaxel, gemcitabine and oxaliplatin) were chosen to analyse the impact of dose banding over a 3 month period in 2020 and between the year before and after implementation. For the 3-month analysis, patients were identified if they were dispensed one of these drugs and there was a change in body surface area that would have resulted in a new calculated dose but no change in the banded dose. For the year to year analysis, the percentage of these drugs that were recycled (cancelled treatments re-labelled for another patient with the same dose) were compared.
Results: 52 patients were identified with paclitaxel, gemcitabine or oxaliplatin doses that would have changed and likely discarded if dose banding was not implemented. The financial savings over 3 months for these 3 drugs was calculated to be $7665.15 (as PBS claim value) including 780 minutes of estimated labour saved. The proportion of these drugs recycled in a year significantly increased after dose banding: paclitaxel from 36% to 62%; oxaliplatin 9% to 64% and gemcitabine 14% to 29% which demonstrates a clear reduction in drug wastage.
Conclusion: The implementation of dose banding resulted in a decreased rate of dose recalculations and cancellations, resulting in savings to the PBS and labour hours. It also increased the ability to recycle products, reducing drug wastage.