haematology and oncology
Implications of licensed
standardised chemotherapy
doses and their potential impact
The introduction of dose banding and the recent publication of product specifications
by NHS England have set the ball in motion for the introduction of licensed standardised
chemotherapy doses, the benefits of which are discussed here
Tariro Kabba
MRPharmS DipGPP
Principal Pharmacist
Cancer and Aseptics
Christopher Woodard
Lead Technician and
Aseptics Manager
Milton Keynes University
Hospital NHS Trust, UK
Chemotherapy is the single biggest service
area-spend within NHS England specialised
commissioning. In 2016/17, NHS England spent
approximately £1.7 billion on the routine
commissioning of chemotherapy, with drug costs
accounting for the largest proportion (80%). 1
In 2015 Lord Carter published a report 2 on
productivity and efficiency in the NHS,
identifying £5bn of efficiency opportunities
resulting from unwarranted variation. The report
outlined that potential savings could be made
within the NHS, by improving workflow systems.
The hospital pharmacy and medicines
optimisation programme (HopMOp) was initiated
following the recommendations of Lord Carter
and it has undertaken various projects to be able
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to deliver the efficiency targets as set out in the
report. Since 2016, NHS Trusts in England have
seen the introduction of chemotherapy dose
standardisation through dose banding. Dose
banding is the process by which calculated drug
doses are grouped and set to a pre-defined dose.
Each series of consecutive doses is the ‘band’ and
the dose that they are rounded towards is the
‘banded dose’. 3 Dose banding was launched for
an initial 19 commonly used chemotherapy drugs
to help the NHS achieve value through the ability
to purchase standard off-the-shelf products. 1
The NHS Pharmaceutical Quality Assurance
Committee and the British Oncology Pharmacy
Association (BOPA) have published a guide on
sourcing ready to administer chemotherapy. 3