In the 2019-2020 financial year, Australia dispensed 208 million PBS prescriptions costing $12.614 billion AUD, making reducing medication wastage crucial for healthcare expenditure.[1] Australian medication wastage can be studied using Return of Unwanted Medicines (RUM) bins, which allows safe medication disposal for consumers. Over 2013, $2 million worth of medications in were found in Australian community pharmacy RUM bins, half of which were unused and unexpired (NatRUM study).[2] Although this study investigates medication wastage in the community, there is limited published research quantifying medicine wastage in Australian public hospitals. Our PubRUM study aims to quantity, classify, and describe costs of unwanted and/or expired medications in RUM bins at Footscray Hospital (Victoria, Australia).

 

Five RUM bins were accumulated at Footscray Hospital over October and November 2023. The contents of each bin were sighted by investigators prior to their disposal and various characteristics of the medications were recorded, including formulation, expiry dates, and quantity remaining. Medications were then categorised based on type, formulation, sharability, and expiration, then costed based on pharmacy data. Footscray Hospital produces an average of five RUM bins a month allowing data to be extrapolated to annual figures. All data collection, storage and extraction was conducted in compliance with Western Health (WH) ethics committee approval (ref. QA2021.114_82071). 

 

From five RUM bins at Footscray Hospital, 2250 medications were screened, revealing significant medication wastage. Respiratory medications accounted for the highest yearly estimated cost of wasted medications at $36,940 (32%), followed by cardiovascular at $21,381 (19%) and central nervous system medications at $16,919 (15%). In contrast, immunological products, and vaccines, though costly per unit ($23.10), had minimal yearly estimated cost wastage of $554.40 (0.48%). Capsules and tablets formulations represented 48% of the total cost of wasted medication drug forms, followed by powders (31%) and liquids (10%). The estimated total yearly cost of medication wastage, extrapolated from the collected data, amounted to $115,051. This underscores the significant financial impact of medication wastage.

 

 

Both in-date and expired medications were found discarded in the bins. Multiple reasons exist for the disposal of in-date medications. Non-sharable in-date medications are deliberately discarded e.g. respiratory MDIs, representing 95% of the total cost of discarded respiratory medications. Inexpensive in-date medications costing less than $1 are deliberately discarded as per Footscray Hospital policy, due to high labour cost repurposing cheap medications. 91% of antihypertensive medications found in the study bins cost less than $1. Other reasons for discarding in-date medication include separation of patient’s medications at points of transfer (ED, ward, discharge) and inpatient discontinuation. Implementing policy and protocol change to prevent medication wastage is expensive. This study suggests efforts to curtail medication wastage ought to best focus on frequently prescribed, expensive medications.

 

This is the first study known to the authors that evaluates the cost of medications discarded in an Australian public hospital. Improving hospital protocol is costly and labour intensive. This study illuminates high-cost, high-waste medication groups on which future implementation projects can focus. The estimated annualised cost of discarded medications was ~$115,000. The most expensive discarded medications were the respiratory, cardiovascular, and central nervous system drugs, which cost 30%, 15%, and 14% respectively. Representing 95% of the cost of the respiratory medications, MDIs and powder based inhalers represent our foremost recommendation on which to focus implementaiton efforts to reduce hospital medicaiton waste.

 

Conflicts of interest:
none.

 

[1] PBS Information Management Section. (2020). PBS Expenditure and Prescriptions Report 1 July 2019 to 30 June 2020. https://www.pbs.gov.au/statistics/expenditure-prescriptions/2019-2020/PBS_Expenditure_and_Prescriptions_Report_1-July-2019_to_30-June-2020.pdf

 

[2] Return Unwanted Medicines. (2013). The National Return and Disposal of Unwanted Medicines (NatRUM) Project Audit: Final Report. https://returnmed.com.au/wp-content/uploads/2017/08/NatRUM-Project-Audit-Final-Report-Monash.pdf

 

Keywords: medication wastage, PBS, public hospital, sustainability