Aims
Common oncology practice calculates individualised weight- or body surface area-based dosing, yet it inherently generates discarded leftover drug due to mismatch with single-use vial sizes. Given the high acquisition costs and resource-intensive manufacturing of medications such as monoclonal antibodies (mAbs), this waste drives a significant financial and environmental burden. The strategy of automated dose banding reduces this waste by grouping patient doses into predefined ranges. This study aimed to evaluate the financial savings and provide a preliminary quantitative assessment of the environmental benefits of an automated dose banding strategy within an Australian public health framework.
Methods
A retrospective clinical audit was conducted at a tertiary public hospital for patients receiving anticancer mAbs for solid and haematological malignancies between January 2020 and December 2025. Financial savings were calculated as the difference between the price of the vials for the theoretical unbanded dose and the price of the vials for the dispensed banded dose. The amount and value of drug saved were calculated using time-accurate historical acquisition costs. Carbon dioxide equivalent (CO2e) emissions were estimated using an agent-specific streamlined life-cycle assessment (LCA) factor for nivolumab, and a generic LCA factor for the remaining mAbs.
Results
Across 3,869 automated dose-banded administrations for 454 patients receiving eight anticancer mAbs, the dose banding strategy yielded total savings of $252,620. Mean savings were $65 per administration and $556 per patient, driven by a combination of high prescribing volumes and high acquisition prices. In total, 146,630 mg of mAb dose was conserved, avoiding an estimated 3.44 tonnes of CO2e emissions.
Conclusions
The application of automated dose banding of anti-cancer mAbs in a tertiary Australian health service delivers significant financial savings and may lead to environmental benefits. This information can be generalised to other health services and guide national prescribing policy.