TORONTO – The company at the centre of a storm over diluted chemotherapy drugs was charging far less for bags filled with the drug-and-saline mixture than the previous long-standing supplier, a legislative committee heard Tuesday.
Marchese Hospital Solutions was offering a service charge of just $5.60 and $6.62 per bag, while Baxter Corp., which was bidding to renew a contract it had since 2008, priced them between $21 and $34, the committee heard.
The New Democrats say it must have been a major factor that prompted Medbuy, the bulk purchaser for hospitals, to switch to Marchese from Baxter last year.
Medbuy says price had nothing to do with it, but that’s hard to believe, said NDP health critic France Gelinas. “Really? The numbers don’t match,” she said after the hearing. “The data we have in front of us do not support what those people have told us.”
It’s now known that the Marchese bags containing cyclophosphamide and gemcitabine had too much saline, in effect watering down the prescribed drug concentrations by up to 20 per cent.
Just over 1,200 cancer patients in Ontario and New Brunswick received the diluted drugs, some for as long as a year.
Marchese has said it prepared the drugs the way it was asked to under its contract and under the supervision of a licensed pharmacist.
But Medbuy, which put out the call for bids on the contract, said Marchese didn’t meet the requirement to provide an exact concentration of the drugs in the saline solution.
Bags of saline contain some extra liquid to account for evaporation. But Marchese didn’t account for it, thinking each bag would be given to a single patient, the committee heard.
Their labels also didn’t indicate how much additional saline, called “overfill,” was in the bag.
Marchese president Marita Zaffiro had previously testified that the company didn’t know the bags were being used for multiple patients, and that it wasn’t specified or discussed at any time since it started supplying the five hospitals in 2012.
Zaffiro said Marchese supplied products that weren’t “concentration specific,” meaning they only put a set amount of the drug in each bag, rather than creating a mixture that contained a certain concentration of the drug per millilitre of saline.
But the hospitals thought they were getting what Baxter had previously provided – bags of a certain concentrate that had been adjusted for the extra saline – and administered it accordingly.
A pharmacy assistant at a Peterborough, Ont., hospital that had just started using the Marchese products discovered the problem when he noticed that the Marchese label only listed the amount of the drug gemcitabine in the bag – four grams – not the final concentration of the drug per millilitre of saline.
The labels on products from Baxter, which has been in the business of admixing for 27 years, listed both.
Administering four grams of gemcitabine to a single patient would have been harmful, the committee heard.
“In order for a four gram dose to be used as a single patient dose, using a standard five-foot-10-inches tall patient, you’re looking at a patient of over 900 pounds,” said Anne Miao, Baxter’s director of pharmacy.
To a pharmacist, concentration can be represented as the active ingredient over a total volume or over a unit volume, said Miao. “So concentration is concentration,” she said. “And what I believe the difference is that we know that gemcitabine four grams was not going to be used as one single dose for a patient.”