Abstract ECONOMIC IMPACT OF WASTE IN PRESCRIBING, DISPENSING, AND MEDICATION CONSUMPTION IN THE UNITED STATES By Sarah A. Almanie, M.S. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University. Virginia Commonwealth University, 2015. Major Director: David A. Holdford, R.Ph., M.S., Ph.D., FAPhA Professor Department of Pharmacotherapy and Outcomes Science OBJECTIVES: This research examines waste associated with the medication use process which consists of unfilled prescriptions, abandoned prescriptions, or unused prescription medications. The aim of this study is to quantify the direct medical costs of medication waste in delivery of care in the United States. METHODS: A review of published literature and data from the 2012 Medical Expenditure Panel Survey was used to quantify the number of prescriptions wasted at different stages of the medication prescribing and use process and the associated costs were calculated. RESULTS: In 2012, more than 26 million prescriptions were either unfilled or abandoned, and more than 225 million resulted in dispensed medications that were not used. The total cost of this waste was estimated at $30.4 billion. CONCLUSIONS: Patients who do not fulfill their role in the medication use process cause significant, avoidable costs to the health care system beyond the health outcomes not achieved.

Medication waste, both packaging and actual drug waste, has been having a tremendous impact on the environment and healthcare budget. However, this is even more concerning after Covid-19 affects the drug purchasing behaviours and causes potentially more unused medications while many people are not able to access healthcare. Some of the main challenges of lack of contribution to the life after the purchase of unused medicine are the patient’s lack of knowledge of how to dispose of them, the medication distribution, the legislation and not having an encouraging sustainable system to reduce medication waste on a bigger scale. This project focused on understanding medicine usage behaviours in Turkish society and developing a circular model called U-Med (Unused Medications). The model has a mobile application and reverse vending machines which are linked with e-Nabız (e-Heartbeat, an application that Turkish citizens and health professionals access to health data collected from health institutions) to reduce medication waste by providing individuals to dispose of or share their unused medicines with the healthcare system or the other industries that can reuse. The concept also aims to show a sustainable approach which can influence decision-making in legislation on medication distribution. This project includes face-to-face, semi-structured interviews in a neighbourhood in Sarıyer, Istanbul Turkey with 5 patients, 3 doctors, 3 nurses and 5 pharmacists along with the health director in the municipality of Sarıyer. Additionally, remote interviews were organised with a non-profit organisation in Greece called GIVMED which has similar concerns. Apart from these, a Turkish survey among 88 Turkish citizens about medication usage behaviour was conducted.