Reduced pharmacy resource utilization associated with raltitrexed treatment of advanced colorectal cancer

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Abstract
Objective. The pharmacy resources needed for prep aration of the direct, specific thymidylate synthase inhibitor raltitrexed (`Tomudex' ; Zeneca Pharmaceu ticals, Ltd., Macclesfield, UK); the Mayo, Machover, and De Gramont regimens of 5-fluorouracil (5-FU) and calcium leucovorin (LV); and continuous intravenous 5-FU for the treatment of advanced colorectal cancer were compared. Design. The pharmacy time spent on prepara tion, the disposables used, and associated drug wast age were recorded and costed for a treatment cycle. Patients. Colorectal cancer patients receiving standard treatment or included in a clinical trial in a large teaching hospital were considered. Outcome Measures. The pharmacy preparative time, labor, disposable, and drug wastage costs per treatment cycle, prepared extemporaneously and us ing a batch process, were measured. Results. A cycle of raltitrexed was much quicker to prepare than any other regimen (P < .05). The labor costs were significantly less (£2.87 for ralti trexed compared with £5.24-19.67 for the 5-FU regi mens) particularly with respect to the Machover regimen, which incurred costs seven times those of raltitrexed. The cost of disposables was significantly lower for raltitrexed, with continuously infused 5-FU incurring the greatest cost. As expected for a new treatment assessed within a clinical trial rather than in a routine setting, drug wastage was higher for ralti trexed (P < .05) except when compared with batch- preparation for the Machover regimen. Conclusions. Raltitrexed was quicker and sim pler to prepare than 5-FU- based regimens for colo rectal cancer. This resulted in lower pharmacy labor and disposable costs, although in this study drug wastage was higher for raltitrexed prepared under clinical trial conditions.

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