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Solid oral forms availability in children: a cost saving investigation
Audrey Lajoinie1, Emilie Henin, Behrouz Kassai
1EPICIME-CIC 1407 Inserm, Service de Pharmacologie Clinique, Hospices Civils de Lyon Lyon, F-69677, Bron, France; Université Lyon 1, UMR 5558 CNRS, Laboratoire de Biométrie et Biologie Evolutive, F-69622, Villeurbanne, France.
Insights
Substituting liquid medicines with solid forms for children over 2 years could lead to significant cost savings. This approach offers considerable financial benefits for both hospitals and the community, making it a viable consideration.
Area of Science:
- Pediatric Pharmacy
- Pharmaceutical Sciences
- Health Economics
Background:
- Oral liquid medicines are commonly prescribed for pediatric patients.
- Challenges exist in administering liquid medications, including accurate dosing and patient adherence.
- The cost-effectiveness of alternative dosage forms is an important consideration in pediatric pharmacotherapy.
Purpose of the Study:
- To evaluate the feasibility of substituting oral liquid medications with solid dosage forms for children over 2 years old.
- To assess potential cost savings associated with this substitution from both hospital and community perspectives.
- To determine the suitability of available solid alternatives based on dosage and age-appropriateness.
Main Methods:
- A 1-week sample of dispensed oral liquid medicines from a UK pediatric hospital was analyzed.
- Screening for available solid form alternatives and assessing their acceptability regarding prescribed dose and child's age.
- Cost calculations were performed for 28-day treatment durations or prescribed short-term durations.
Main Results:
- Over 90% of liquid formulations had a marketed solid form alternative.
- Approximately 80% of liquid medications were suitable for substitution based on dosage acceptability criteria.
- An estimated £5K-£8K weekly savings were identified, projecting annual savings of £238K-£410K per institution.
Conclusions:
- Substitution of oral liquid formulations with suitable solid dosage forms can yield substantial drug cost savings.
- While not all children can swallow solid forms, the financial benefits support further investigation into strategies for facilitating tablet/capsule ingestion in pediatric patients.
- Solid dosage forms offer numerous advantages over liquids, warranting investment in methods to support their use in children.
Aim:
To assess the suitability and potential cost savings, from both the hospital and community perspective, of prescribed oral liquid medicine substitution with acceptable solid forms for children over 2 years.
Method:
Oral liquid medicines dispensed from a paediatric hospital (UK) in 1 week were assessed by screening for existence of the solid form alternative and evaluating the acceptability of the available solid form, firstly related to the prescribed dose and secondly to acceptable size depending on the child's age. Costs were calculated based on providing treatment for 28 days or prescribed duration for short term treatments.
Results:
Over 90% (440/476) of liquid formulations were available as a marketed solid form. Considering dosage acceptability (maximum of 10% deviation from prescribed dosage or 0% for narrow therapeutic range drugs, maximum tablet divisions into quarters) 80% of liquids could be substituted with a solid form. The main limitation for liquid substitution would be solid form size. However, two-thirds of prescribed liquids could have been substituted with a suitable solid form for dosage and size, with estimated savings being of £5K and £8K in 1 week, respectively based on hospital and community costs, corresponding to a projected annual saving of £238K and £410K (single institution).
Conclusion:
Whilst not all children over 2 years will be able to swallow tablets, drug cost savings if oral liquid formulations were substituted with suitable solid dosage forms would be considerable. Given the numerous advantages of solid forms compared with liquids, this study may provide a theoretical basis for investing in supporting children to swallow tablets/capsules.