In February 2018, the NICE has published a document on Key therapeutic topic [KTT22] that summarizes the evidence-base on chemotherapy dose standardization. It is a key therapeutic topic, which has been identified to support medicines optimization. It is not a formal NICE guidance. It is a new topic for the 2018 update of medicines optimization.

Chemotherapy dose standardization, where hospital trusts move to a system of dose banding, has the potential to offer considerable benefits for patients, providers, and commissioners.

NHS England's Medicines Optimization and Chemotherapy Clinical Reference Groups are coordinating a national approach to chemotherapy dose standardization with the objective that all NHS England commissioned providers of chemotherapy move to prescribing and supplying a range of intravenous anticancer therapy in accordance with a nationally approved set of dose bands.

Evidence context

Chemotherapy dose standardization is a system where doses of intravenous anticancer therapy calculated on an individualized basis are rounded up or down to predetermined standard doses.

Historically, intravenous chemotherapy doses have been calculated for individual patients based on weight or body surface area. This has led to a large number of similar, but not identical, products being made as bespoke orders within compounding units. These small product differences significantly increase time and costs of preparation and costs of drug wastage. There is no robust evidence to suggest that standardized doses affect toxicity or clinical outcomes.

It is estimated that NHS England spends approximately 1.5 billion GBP on the routine commissioning of chemotherapy, with medicine costs being the largest proportion of this spend (80%). There is also a high rate of annual growth in these costs of approximately 8% per year.

Standardization of chemotherapy doses, where hospital trusts move to a system of dose banding, offers an avenue for achieving improved value in this area and benefits for patients, providers, and commissioners. The discrete dose bands lie within 6% of the patient's calculated dose for standard chemotherapy drugs and 10% for biological drugs. Available products can then be standardized to match the recommended doses.

Implementation of chemotherapy dose banding has been taking place, to variable degrees, in hospital trusts within England for the previous 10 years, and most providers of chemotherapy will already be dose banding to some extent. However, there is still considerable variation in both the methods of dose banding used and the range of drugs that dose banding has been applied to. An NHS England survey of NHS Providers found that 90% of the 94 trusts who responded were dose banding at least 1 intravenous anticancer therapy. But for the 20 most commonly dose-banded drugs, on average, just 30% of trusts were dose banding. In Scotland, where dose banding of intravenous anticancer therapy has been established for a number of years, it has been estimated that 60%–70% of all intravenous anticancer therapy is administered as dose-banded preparations.

There are currently 54 chemotherapy drugs with approved dose-banding tables.

Alongside standardized doses, the next step of the initiative is to standardize chemotherapy products by diluent, volume, and labeling. This is the precursor to accessing ready-to-administer chemotherapy from the generic and NHS manufacturers.