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E-raamat: Medications in Single-Dose Vials: Implications of Discarded Drugs

  • Formaat: 174 pages
  • Ilmumisaeg: 10-Mar-2021
  • Kirjastus: National Academies Press
  • Keel: eng
  • ISBN-13: 9780309682107
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  • Formaat: 174 pages
  • Ilmumisaeg: 10-Mar-2021
  • Kirjastus: National Academies Press
  • Keel: eng
  • ISBN-13: 9780309682107
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Every year, significant amounts of expensive drugs are discarded. This is due in part to the growing number of prescription drugs that are administered in variable doses (rather than fixed or flat doses) based on a patient's weight or body size. Strict regulations and guidance generally prohibit or severely restrict the acceptable time frame for sharing medication from single-dose vials among patients, and so the unused amount will typically be discarded. Due to the current system for producing, administering, and paying for drugs in the United States, significant - but indeterminate - amounts of expensive prescription drugs are discarded each year.



At the request of the Centers for Medicare & Medicaid Services, Medications in Single Dose Vials: Implications of Discarded Drugs explores the federal health care costs, safety, and quality concerns associated with discarded drugs that result from the weight-based dosing of medicines contained in single-dose vials.

Table of Contents



Front Matter Summary 1 Introduction 2 Single-Dose Vials of Weight-Based Drugs 3 Scope of Discarded Drugs from Single-Dose Vials 4 Efforts to Reduce Discarded Weight-Based Drugs 5 Discarded Weight-Based Drugs in Single-Dose Vials 6 Prescription for Reducing Discarded Drugs Appendix A: Glossary Appendix B: Supplemental Figures and Tables from Commissioned Analyses Appendix C: Stakeholder Input Appendix D: Biographical Information Appendix E: Disclosure of Unavoidable Conflicts of Interest
Preface xv
Summary 1(16)
1 Introduction
17(14)
Study Charge
18(1)
Committee's Approach
19(2)
Context of Rising Health Care Costs
21(4)
Question of Waste
25(1)
Structure of the Report
26(2)
References
28(3)
2 Single-Dose Vials Of Weight-Based Drugs
31(30)
Drug Discovery and Development Process
32(3)
Drug Dosing
35(4)
Vial Sizes
39(2)
Guidance from Federal and Nongovernmental Organizations
41(4)
Clinician Acquisition of and Payment for Drugs
45(8)
Patient Quality of Care
53(1)
Key Findings
54(1)
Conclusions
55(1)
Recommendations
56(1)
References
57(4)
3 Scope Of Discarded Drugs From Single-Dose Vials
61(14)
Analysis of Medicare Spending on Discarded Drugs
62(8)
Analysis of Private Payers' Spending on Discarded Drugs
70(3)
Limitations
73(1)
Key Findings
73(1)
Conclusions
74(1)
Recommendation
74(1)
References
74(1)
4 Efforts To Reduce Discarded Weight-Based Drugs
75(18)
U.S. Congress
75(1)
Professional Organizations
76(2)
Clinical Practices
78(7)
U.S. Department of Health and Human Services Partnerships with Federal and Nonfederal Partners
85(2)
Integrated Health Care Delivery Systems, Traditional Fee-for-Service Systems, and the Underserved
87(1)
Key Findings
88(1)
Conclusions
88(1)
Recommendations
89(1)
References
90(3)
5 Discarded Weight-Based Drugs In Single-Dose Vials
93(16)
Why Are Drugs So Expensive?
94(2)
Approaches to Managing Drug Costs
96(4)
Economics of Packaging Weight-Based Drugs
100(2)
Value of Unused Single-Dose Vial Drugs
102(1)
Role of Reimbursement in Shaping Attitudes Toward Discarded Drugs
102(3)
Likely Unintended Consequences of Efforts to Reduce Discarded Drugs
105(1)
Key Findings
106(1)
Conclusions
107(1)
Recommendation
107(1)
References
107(2)
6 Prescription For Reducing Discarded Drugs
109(14)
Goals and Recommendations
110(7)
Interdependencies of Recommendations
117(4)
A Pivotal Time for Action
121(2)
APPENDIXES
A Glossary
123(4)
B Supplemental Figures And Tables From Commissioned Analyses
127(14)
C Stakeholder Input
141(2)
D Biographical Information
143(10)
E Disclosure Of Unavoidable Conflicts Of Interest
153