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  • The High Costs of Rx Waste

    By Lynda Seminara
    Selected and Reviewed By: Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, October 2019

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    Tauber et al. looked at the effect of unused pharmaceuticals related to phacoemulsification surgery and found the financial and environmental burdens to be high, particularly for discarded eyedrops.

    For this descriptive qualitative study, the authors included four surgical sites in the northeastern United States: a private ambulatory care center, a private tertiary care center, a federally run medical center for veterans, and a pri­vate outpatient facility. Pricing and other data for use of services and pharma­ceuticals were obtained for each facility. The volume or weight of medications remaining after routine phacoemulsi­fication procedures (without vitreous loss or other complications) was mea­sured. From these data, the mean costs of medications were calculated per case and per month. Environmental effects were estimated by economic models of input-output lifecycle assessment.

    Primary outcomes were the cost of unused pharmaceutical products (in U.S. dollars) and the potential carbon footprint of cataract surgery, as eval­uated in the kilogram equivalents of carbon emissions (carbon dioxide [CO2-e]), air pollution (fine partic­ulate matter emissions of ≤10 μm in diameter [PM10-e]), and eutrophication potential (nitrogen [N-e]).

    A total of 116 unique drugs were assessed among the four centers. A cumulative mean 83,070 mL of 183,304 mL per month (45.3%) of pharma­ceuticals were unused by weight or volume. (Unmeasured medications were assumed to have no excess left over.)

    The annual cost of unused products per site was approximately $195,200. The product type with the greatest amount of waste was eyedrops (65.7% by volume), followed by systemic drugs (59.9%) and injections (24.8%). With regard to pollution, monthly unused products at the ambulatory care center (65.9% by volume), tertiary care center (21.3%), federal medical center (38.5%), and outpatient facility (56.8%) resulted in unnecessary poten­tial emissions of 2,135, 2,498, 418, and 711 kg CO2-e per month, respectively. Unnecessary potential air pollution among the sites varied from 0.8 to 4.5 kg PM10-e per month, and unnecessary eutrophication potential ranged from 0.07 to 0.42 kg N-e per month.

    If these findings can be substantiated and shown to be generalizable in the United States or elsewhere, efforts to reduce such costs may be of value, said the authors. Larger-scale, multicenter studies should be helpful for under­standing the full extent and effects of unused pharmaceuticals. Of note in this study: The surgeons and OR staff were not involved in data reporting or analysis, but they were aware of the nature of the study, which may have in­fluenced their use of materials and led to underestimation of the total waste. (See also related commentary by Paul Lee, MD, JD, in the same issue.)

    The original article can be found here.