Authors (including presenting author) :
Tsui HL(1), Yu SM(1), Chong CH(2)
Affiliation :
(1)Department of Radiology and Organ Imaging, (2)Pharmacy, United Christian Hospital
Introduction :
Hepatocellular carcinoma(HCC) is a major cause of morbidity and mortality in Hong Kong. Transarterial chemoembolization(TACE) has shown efficacy in HCC therapy with palliative therapeutic intent or as a bridge to liver transplantation. In our hospital, the pharmacy prepares two syringes of 20ml 1:1 Lipiodol and Cisplatin chemomixture for each TACE case. However, the price for Lipiodol has been rising. Majority of cases used only one syringe from experience.
Objectives :
To evaluate the usage of chemomixture in TACE service, and propose amendment in drug prescription workflow in order to save costs without compromising clinical service and quality.
Methodology :
TACE performed between December 2018 and May 2019 were retrieved with age of patient, volume of chemomixture dispensed and administered, technique of catheterization during TACE, number and size of HCC, involved segments were recorded. Chemomixture prescription form was amended after discussion with department head and senior pharmacist, allowing a selection to prescribe 20ml or 40ml of chemomixture for each case. TACE examinations performed after prescription form amendment between mid-September and mid-December 2019 were retrieved with chemomixture usage recorded. Correlation between drug use and technique was analysed with oneway ANOVA test. Correlation between drug use and size of HCC, number of HCC and segment of HCC involvement were analysed with linear regression. Differences in parameters between patients in both periods were analysed by t-test. p< 0.05 was taken as significant.
Result & Outcome :
Between December 2018 and May 2019, 91 TACE performed with 3640ml chemomixture dispensed and 1465ml(40.2%) administered . 66/91(72.5%) cases used 20ml or less chemomixture with a mean of 23.9ml chemomixture wasted per case. Volume of chemomixture decreases with superselective catheterization of hepatic arteries(p=0.004); increases with size of HCC (p< 0.0001), number of HCC(p< 0.0001) and segment of HCC involvement(p< 0.0001). After prescription form amendment, 45 TACE were performed between 18th September and 23rd December 2019. A total of 1180ml chemomixture was dispensed with 809.5ml administered(68.6%). A mean of 8.2ml chemomixture was wasted per case(p< 0.0001). No statistical significant difference between age of patients, size and number of HCC and segment involvement in pre- and post-amendment groups. Evaluation of chemomixture usage in 2020 showed 113/197(57.3%) cases prescribed 20ml chemomixture, contributing to cost saving of $244,080. Careful selection of patients and screening of each case before chemomixture prescription, will likely reduce chemomixture wastage and achieve cost saving without compromising clinical service and quality.
