The Antiblastic Preparation Laboratory of the Pharmacy in the Policlinico “San Martino” in Genoa prepares on average 250 daily injectable and oral antiblastic therapies. These are high-cost therapies that account for about 30% of the total budget of the Pharmacy. The most critical preparations are those injective which account for 80% of the total. For intravenous (i.v.) preparations, the Laboratory uses the automated system APOTECAchemo robot (Loccioni, Italy) which guarantees the highest quality and control standards for i.v. preparations. In the first quarter of 2017 this robotic system was used for about 40% of injections. The objective of progressive implementation and enhancement of the automated set-up has focused on overfilling drugs. Since October 2017 the overfilling values of some high-cost drugs have been progressively included in the APOTECA software in order to use all the available drug for the therapy and to obtain an economic saving of the pharmaceutical expenditure. The overfilling of nivolumab 100 mg/10 ml vials, pembrolizumab 100 mg/4 ml, cetuximab 100 mg/20 ml, rituximab 500 mg/50 ml (two different biosimilar), bevacizumab 400 mg/16 ml, daratumumab 400 mg/20 ml and carfizomib 60 mg was measured and included in the robot software. Then, the number of vials prepared for the therapy, the number of vials used by the robot and the relative saving of economic resources was calculated for each drug, from the date of inclusion of the overfilling. From October 2017 to May 2019 a total of over 12,500 vials for therapy were prepared with an average saving of about 590 vials and € 700,000.

The progressive implementation of the robotic device for automated system has led to the current 70% of the antiblastic drugs prepared with robot. A further increase may come from the drugs used for clinical trials and from the optimization of the use of the automated system to 100% of its potential. The introduction of a second robot for the total preparation of oncohematological therapies is also being valued.

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Key words: antiblastic therapy, automated system, i.v.-compounding robot, overfilling