A New Perspective on Drug Vial Optimization

Purpose: Historically, MD Anderson Cancer Center pharmacy areas utilized a strategic process referred to as, drug vial optimization (DVO) to extend the beyond-use date for single-use intravenous drug products. Under this strategy, partially used vials of drug were available for a greater period of time to satisfy medication orders prior to having to be discarded. This ultimately resulted in a reduction of drug waste and associated reduce drug cost. Recently updated USP chapter <797> guidelines has since halted the ability to utilize this strategy further. It became prudent to identify a new waste mitigation strategy. MD Anderson Cancer Center Outpatient Pharmacy began a focused effort of ordering the smallest vial size commercially available of rituximab to in an effort to minimize partial vial waste. This process is referred to as, drug vial size optimization (DVSO). Methods: A retrospective review of data related to rituximab administration and waste reports at MD Anderson outpatient-pharmacy between March 2019 and January of 2020 was conducted. Results: For MD Anderson outpatient pharmacy, it was discovered that the percent of waste of weekly rituximab use increased from near zero percent to 6.9% (p<0.001) per week following cessation of the DVO process. Following implementation of DVSO, the percent of waste of weekly rituximab reduced to 3.9% to a new weekly average of 3.0% (p<0.001).