Aims: The Australian Government review of the Efficient Funding of Chemotherapy (EFC) arrangement recommended introducing dose banding, but there is limited real-world Australian data on cost implications. The aim of this pilot analysis was to investigate the potential cost impact of introducing chemotherapy dose banding, through analysis of six commonly prescribed drugs.
Methods: A retrospective data extraction was conducted of orders (1/7/2023 to 30/10/2023) for six chemotherapy drugs, namely carboplatin, docetaxel, fluorouracil, gemcitabine, oxaliplatin and paclitaxel. A target banded dose using the National Health System England Dose Banding Tables was assign from prescribed dose. Difference between prescribed and banded dose was calculated for dose in milligrams and for vials required to compound the two doses, then the EFC review averaged price per milligram of each drug used to costs these differences.
Results: A total of 9018 orders were included in the study, with 37.2% for fluorouracil, 18.2% paclitaxel, 14.3% gemcitabine, 13.3% carboplatin, 10.9% oxaliplatin and 6.1% docetaxel. Total dose difference between prescribed and banded dose increased for each drug: fluorouracil 50030.2mg; gemcitabine 5003.18mg; carboplatin 2858mg; paclitaxel 2367.8mg; docetaxel 268mg and oxaliplatin 73mg. The difference in vials required to compound banded doses decreased for carboplatin, oxaliplatin, gemcitabine and fluorouracil, but increased for docetaxel and paclitaxel. Total differences in costs were an increase of $5580.93 based on milligrams but decrease of $24816.50 based on vials.
Conclusions: Potential cost implications of dose banding chemotherapy varied substantially depending on pricing according to milligram or vial, both of which were recommended by the EFC review. This preliminary analysis suggests services, especially pharmacy, may be financially impacted regardless of proposed changes introduced. Further studies are needed in more chemotherapy agents to fully understand the financial implications of chemotherapy dose banding in Australia.