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The economics of a pharmacy-based central intravenous additive service for paediatric patients
D J Armour1, C J Cairns, I Costello
1Pharmacy Academic Practice Unit, St George's Hospital, London, England.
Insights
Pharmacy-based Central Intravenous Additive Services (CIVAS) are more cost-effective for paediatric intravenous dose preparation than traditional ward-based methods. CIVAS significantly reduces labour, disposable, and diluent costs, offering substantial annual savings and improved workflow efficiency.
Area of Science:
- Health Economics
- Pharmaceutical Sciences
- Paediatric Care
Background:
- Traditional ward-based preparation of intravenous doses is resource-intensive.
- Pharmacy-based Central Intravenous Additive Services (CIVAS) offer a potential alternative for optimizing medication preparation.
- Evaluating the economic impact of CIVAS in paediatric settings is crucial for healthcare resource allocation.
Purpose of the Study:
- To compare the costs of pharmacy-based CIVAS with traditional ward-based intravenous dose preparation for paediatric patients.
- To quantify labour, disposable, and diluent costs associated with each preparation method.
- To assess cost savings, including those from vial reuse, and workflow benefits of CIVAS.
Main Methods:
- A comparative cost analysis was conducted between CIVAS and ward-based preparation.
- Labour costs were determined by direct observation and timing of dose preparation.
- Costs of disposables and diluents were recorded and allocated per dose; avoided costs from vial reuse were also calculated.
Main Results:
- CIVAS demonstrated significantly lower labour, disposable, and diluent costs compared to ward-based preparation (p < 0.001).
- The cost ratio per dose between ward and pharmacy was 2.35:1 (£2.51 vs £1.07 in 1994 pounds sterling).
- Sensitivity analysis confirmed CIVAS cost-effectiveness across various staff mixes, with cost ratios ranging from 2.3:1 to 4.0:1.
Conclusions:
- Pharmacy-based CIVAS is more economical than traditional ward-based preparation for paediatric intravenous doses, achieving cost minimization.
- Significant annual savings, estimated at £44,000, were identified from the multiple use of vials in CIVAS.
- CIVAS offers improved workflow resilience and cost advantages irrespective of staff skill mix.
Abstract:
This study was designed to compare the costs of a pharmacy-based Central Intravenous Additive Service (CIVAS) with those of traditional ward-based preparation of intravenous doses for a paediatric population. Labour costs were derived from timings of preparation of individual doses in both the pharmacy and ward by an independent observer. The use of disposables and diluents was recorded and their acquisition costs apportioned to the cost of each dose prepared. Data were collected from 20 CIVAS sessions (501 doses) and 26 ward-based sessions (30 doses). In addition, the costs avoided by the use of part vials in CIVAS was calculated. This was derived from a total of 50 CIVAS sessions. Labour, disposable and diluent costs were significantly lower for CIVAS compared with ward-based preparation (p < 0.001). The ratio of costs per dose [in 1994 pounds sterling] between ward and pharmacy was 2.35:1 (2.51 pounds:1.07 pounds). Sensitivity analysis of the best and worst staff mixes in both locations ranged from 2.3:1 to 4.0:1, always in favour of CIVAS. There were considerable costs avoided in CIVAS from the multiple use of vials; the estimated annual sum derived from the study was 44,000 pounds. In addition, CIVAS was less vulnerable to unanticipated interruptions in work flow than ward-based preparation. CIVAS for children was more economical than traditional ward-based preparation, because of a cost-minimisation effect. Sensitivity analysis showed that these advantages were maintained over a full range of skill mixes. Additionally, significant savings accrued from the multiple use of vials in CIVAS.