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National Health Service England introduces dose banding
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National Health Service England introduces dose banding National Health Service (NHS) England is introducing a national programme of dose banding for intravenous chemotherapy drugs in which doses calculated according to a patient’s body surface area are grouped into predefined dose ranges or bands. Patients will be treated with standard doses equating to the mid-point of the dosing band into which their dose falls with drugs provided in standard single serve doses, with the aim to reduce drug wastage and costs. NHS trusts have previously purchased large quantities of chemotherapy drugs that hospital pharmacy teams split into doses for each patient, often wasting drug left over. By contrast, dose bands are matched to vial sizes and doses can also be made up in advance. Several areas in England have already introduced dose banding and almost 90% of NHS trusts use it for at least one chemotherapy drug.
“This programme of work seeks to build on the best practice in these areas. Through doing so we can reduce error, wastage and clinical time, as well as facilitate other initiatives such as e-prescribing, where standard dosing would reduce the time taken to adopt the technology,” says Jonathan Fielden, Director of Specialised Commissioning and Deputy Medical Director at NHS England. NHS England plans to have at least 90% of chemotherapy doses prescribed using dose banding by March, 2018, with a financial incentive scheme to encourage trusts to adopt the approach. It applies initially to 19 commonly used chemotherapy drugs, including cisplatin and vincristine, but the Chemotherapy Clinical Reference Group is reviewing all intravenous chemotherapy drugs dosed on the basis of a patient’s weight and height.
Etienne Chatelut, (INSERM UMR 1037 and Institut Universitaire du Cancer Toulouse, Toulouse, France) comments, “Dose banding is a very practical approach to improving chemotherapy delivery”. He adds, “The risk to efficacy and safety is close to zero.” His group carried out a retrospective analysis comparing the pharmacokinetics for standard dosing with dose banding in more than 100 patients. “We didn’t see any significant difference in drug exposure between regular dosing and dose-banding even though we used only three broad bands—small, average and large sized people.” The NHS England dose-banding tables are based on ensuring that no dose of chemotherapy can be greater than 6% above or below the calculated dose (10% for monoclonal antibodies).
Lancet Oncol 2016 Published Online May 26, 2016 http://dx.doi.org/10.1016/ S1470-2045(16)30199-1 For more on dose banding for chemotherapy see https://www.england.nhs.uk/ commissioning/spec-services/ npc-crg/group-b/b15 For more on NHS England Medicines Optimisation Clinical Reference Group see https://www.england.nhs.uk/ commissioning/wp-content/ uploads/sites/12/2013/05/dosebanding-tables-how-to.pdf
Susan Mayor
www.thelancet.com/oncology Published online May 26, 2016 http://dx.doi.org/10.1016/S1470-2045(16)30199-1
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National Health Service England introduces dose banding National Health Service (NHS) England is introducing a national programme of dose banding for intravenous chemotherapy drugs in which doses calculated according to a patient’s body surface area are grouped into predefined dose ranges or bands. Patients will be treated with standard doses equating to the mid-point of the dosing band into which their dose falls with drugs provided in standard single serve doses, with the aim to reduce drug wastage and costs. NHS trusts have previously purchased large quantities of chemotherapy drugs that hospital pharmacy teams split into doses for each patient, often wasting drug left over. By contrast, dose bands are matched to vial sizes and doses can also be made up in advance. Several areas in England have already introduced dose banding and almost 90% of NHS trusts use it for at least one chemotherapy drug.
“This programme of work seeks to build on the best practice in these areas. Through doing so we can reduce error, wastage and clinical time, as well as facilitate other initiatives such as e-prescribing, where standard dosing would reduce the time taken to adopt the technology,” says Jonathan Fielden, Director of Specialised Commissioning and Deputy Medical Director at NHS England. NHS England plans to have at least 90% of chemotherapy doses prescribed using dose banding by March, 2018, with a financial incentive scheme to encourage trusts to adopt the approach. It applies initially to 19 commonly used chemotherapy drugs, including cisplatin and vincristine, but the Chemotherapy Clinical Reference Group is reviewing all intravenous chemotherapy drugs dosed on the basis of a patient’s weight and height.
Etienne Chatelut, (INSERM UMR 1037 and Institut Universitaire du Cancer Toulouse, Toulouse, France) comments, “Dose banding is a very practical approach to improving chemotherapy delivery”. He adds, “The risk to efficacy and safety is close to zero.” His group carried out a retrospective analysis comparing the pharmacokinetics for standard dosing with dose banding in more than 100 patients. “We didn’t see any significant difference in drug exposure between regular dosing and dose-banding even though we used only three broad bands—small, average and large sized people.” The NHS England dose-banding tables are based on ensuring that no dose of chemotherapy can be greater than 6% above or below the calculated dose (10% for monoclonal antibodies).
Lancet Oncol 2016 Published Online May 26, 2016 http://dx.doi.org/10.1016/ S1470-2045(16)30199-1 For more on dose banding for chemotherapy see https://www.england.nhs.uk/ commissioning/spec-services/ npc-crg/group-b/b15 For more on NHS England Medicines Optimisation Clinical Reference Group see https://www.england.nhs.uk/ commissioning/wp-content/ uploads/sites/12/2013/05/dosebanding-tables-how-to.pdf
Susan Mayor
www.thelancet.com/oncology Published online May 26, 2016 http://dx.doi.org/10.1016/S1470-2045(16)30199-1
1