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Published on: June 11, 2012
Cost-effectiveness of central automated unit dose dispensing with barcode-assisted medication administration in a
Janique Gabriëlle Jessurun1, Nicole Geertruida Maria Hunfeld2, Monique van Dijk3
1Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, P.O. Box 2040, 3000 CA, the Netherlands.
Insights
Central automated unit dose dispensing (cADD) with barcode-assisted medication administration (BCMA) significantly reduced medication administration errors (MAEs) and potentially harmful MAEs. The cost-effectiveness analysis shows a low cost per avoided error, making it a valuable strategy for enhancing hospital patient safety.
Area of Science:
- Health Economics
- Patient Safety
- Medication Management
Background:
- Central automated unit dose dispensing (cADD) combined with barcode-assisted medication administration (BCMA) is known to decrease medication administration errors (MAEs).
- However, the cost-effectiveness of implementing cADD with BCMA remains largely unexamined.
Purpose of the Study:
- To evaluate the cost-effectiveness of implementing cADD with BCMA in comparison to standard care.
- To quantify the reduction in MAEs and potentially harmful MAEs achieved through this intervention.
Main Methods:
- A prospective before-and-after study with an economic evaluation was conducted in a Dutch university hospital.
- MAEs were assessed via disguised observation across six wards and extrapolated hospital-wide.
- Cost analysis included pharmaceutical services, nursing time, wastage, and materials, using a 12-month incremental costing approach from a hospital perspective.
Main Results:
- The intervention led to a 4.5% absolute reduction in MAEs and a 2.7% reduction in potentially harmful MAEs.
- An estimated 102,210 MAEs and 59,830 potentially harmful MAEs were avoided annually across the hospital.
- The annual incremental cost was €1,808,600, resulting in a cost-effectiveness ratio of €17.69 per avoided MAE and €30.23 per avoided potentially harmful MAE.
Conclusions:
- Implementing cADD with BCMA effectively reduces medication errors, including those with harmful potential, despite increased overall costs.
- The relatively low cost per avoided error suggests this intervention is a significant strategy for improving patient safety in hospital settings.
Background:
Central automated unit dose dispensing (cADD) with barcode-assisted medication administration (BCMA) has been shown to reduce medication administration errors (MAEs). Little is known about the cost-effectiveness of this intervention.
Objective:
To estimate the cost-effectiveness of cADD with BCMA compared to usual care.
Methods:
An economic evaluation was conducted alongside a prospective before-and-after effectiveness study in a Dutch university hospital. The primary effect measure was the difference between the rate of MAEs before and after implementation of cADD with BCMA, obtained by disguised observation in six clinical wards and subsequent extrapolation to the entire hospital. The cost-analysis was conducted from a hospital perspective with a 12-month incremental costing approach. The total costs covered the pharmaceutical service, nurse medication handling, wastage, and materials related to cADD. The primary outcome was the cost-effectiveness ratio expressed as costs per avoided MAE, obtained by dividing the annual incremental costs by the number of avoided MAEs. The secondary outcome was the cost-effectiveness ratio expressed as costs per avoided potentially harmful MAE (i.e. MAEs with the potential to cause harm).
Results:
The intervention was associated with an absolute MAE reduction of 4.5% and a reduction of 2.7% for potentially harmful MAEs. Based on 2,260,870 administered medications in the entire hospital annually, a total of 102,210 MAEs and 59,830 potentially harmful MAEs were estimated to be avoided. The intervention was associated with an increased incremental cost of €1,808,600 annually. The cost-effectiveness ratio was €17.69 per avoided MAE and €30.23 per avoided potentially harmful MAE.
Conclusions:
The implementation of cADD with BCMA was associated with a reduced rate of medication errors, including harmful ones, at higher overall costs. The costs per avoided error are relatively low, and therefore, this intervention could be an important strategy to improve patient safety in hospitals.
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