DANROAD – Redispensing of Unused Cancer Medication

The project will bring together relevant stakeholders to jointly develop workflows, logistics, and systematic handling of the medication’s return, with the aim of conducting a study on the redispensing of selected drugs at OUH, Department X (hematology) and Department R (oncology).

Purpose

The project aims to demonstrate that it is safe and logistically feasible to retrieve and redispense unopened medication that has been dispensed free of charge. This refers to provided medication that is left unused by patients due to side effects or changes in treatment plans.

The project will replicate and expand upon the perspective of a successful Dutch study in order to demonstrate the potential in a Danish context. Like the Dutch study, ROAD (Redispensing Oral Anticancer Drugs), DANROAD will focus on oral cancer medications in pill form.

In the ROAD study, certain patient groups were asked to return unused medication. The medication was provided in sealed bags equipped with a temperature-measuring device. This allowed the returned medication to be thoroughly quality-checked for its appearance, unopened condition, expiry date, and whether it had been stored within the required temperature range for that specific medication.

The Dutch study primarily focused on reducing waste and assessing the economic benefits of reusing medication. The Danish DANROAD study will build on this by also examining the environmental impact and exploring patients’ and relatives’ perspectives.

The project will calculate the economic and environmental impacts and investigate the citizen perspective to demonstrate potential, identify barriers, and provide knowledge that can be used to work towards relevant legislative changes that are necessary for scaling up the effort. 

Background

The project is part of Danish Region’s joint regional strategy for sustainable hospitals. The project contributes with the goal of achieving a 35% reduction of emissions by 2035.

Within the framework of the “Stop Medicinspild” (Stop Medication Waste) project, free-of-charge medication has been identified as a source of medicine waste. Existing guidelines state that unused free-of-charge dispensed medication should be returned to the hospital pharmacy and discarded. However, this medication represents significant value both in terms of economy and supply security, and disposal of unused medication have a substantial environmental footprint.

At the Hematology and Oncology Departments at OUH, approximately 35,000 packages are dispensed to the selected target group each year, corresponding to roughly DKK 170 million.

The Dutch study included 1,071 cancer patients treated with oral cancer medication at home. Their results showed a 68% reduction in wasted medication (which constituted 2.4% of the total dispensed medication costs in the study) and an average annual net saving of at least €576 (US $682 in 2021) per patient included in the study.

Applying these results to Danish conditions, OUH departments could potentially save 2.4% of DKK 170 million — approximately DKK 4,080,000 annually.

Thus, the return of oral cancer medication is anticipated to deliver substantial advantages, including both economic savings and environmental benefits.

Activities

• Phase 0 – Approvals and Preliminary Investigations: Development of the protocol; approval by the Ethics Committee and exemptions from the Medicines Agency; qualification of equipment; development of a systematic process for the return of the medicine
• Phase 1 – Preparation (funded by Region of Southern Denmark’s fund for environmental projects): Purchase of equipment; development of workflows; creation of a guide for hospitals; staff training; developing patient education materials; development of a qualitative research design to explore perspectives of patients
• Phase 2 – ROAD Study: Execution of the study; continuous sharing of results; environmental calculations (in accordance with the regions’ Climate Management Model); economic calculations; investigation of patient and relative perspectives
• Phase 3 – Scaling Perspectives: Workshop on regional scaling; development of an implementation guide for other hospitals and regions; consideration of scaling to other medications; EU collaboration on the re-dispensing of additional drugs and dialogue with legislators.

Partners

• Project Manager: Pharmacology, OUH. Responsible for the study and the national lead on Sustainable Medicines
• Hospital Pharmacy Fyn. Development of workflows, staff training, quality control, and the technical solution for handling returned medication
• Odense University Hospital, Departments X and R. The study is conducted within these departments. Responsible for receiving and re-dispensing the medication
• Health Innovation Centre of Southern Denmark. Organizing workshops on the development of workflows, conducting qualitative research on the citizen perspective, and handling communication.

Project Duration

The project is scheduled to start in March 2025 and will conclude in 2027.