Evaluating the Economic Impact of the PedAMINES App in Reducing Medication Errors in Pediatric Emergency Care:
Loïc Brunner1, Johan N Siebert2,3, Frédéric Ehrler4
1Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Insights
The PedAMINES mobile app significantly reduces pediatric medication errors in emergencies, proving cost-effective by preventing adverse drug events (ADEs). Widespread adoption can reduce healthcare costs and improve patient safety.
Area of Science:
- Health economics
- Pediatric emergency medicine
- Health informatics
Background:
- Pediatric emergency drug administration is complex and error-prone.
- Medication errors in children can lead to adverse drug events (ADEs).
- The PedAMINES mobile app automates dose calculations to improve accuracy.
Purpose of the Study:
- To evaluate the cost-effectiveness of the PedAMINES app for four critical emergency drugs.
- To determine the return on investment for implementing the app in pediatric emergency care.
Main Methods:
- Economic evaluation combining hospital data, trial outcomes, literature, and app maintenance costs.
- Calculation of cost per avoided medication error and administrations needed for positive ROI.
- Monte Carlo simulations to assess parameter uncertainty.
Main Results:
- The app demonstrated a high potential for error reduction across epinephrine, norepinephrine, dopamine, and midazolam.
- Cost-effectiveness ratios per ADE prevented ranged from $2074 to $9705.
- A positive return on investment was achievable with a fraction of annual administrations.
Conclusions:
- The PedAMINES app is an economically viable tool for reducing pediatric drug administration errors.
- National-scale adoption can enhance cost savings and patient safety in emergency care.
Background:
The administration of drugs in pediatric emergency care is a time-consuming process and is associated with a higher occurrence of medication errors compared with adult care. This is attributed to the intricacies of administration, which involve calculating doses based on the child's weight or age. To mitigate the occurrence of adverse drug events (ADEs), the PedAMINES (Pediatric Accurate Medication in Emergency Situations; Geneva University Hospitals) mobile app has been developed. This app offers a step-by-step guide for preparing and administering pediatric drugs during emergency interventions by automating the dose calculation process. Although previous simulation-based randomized controlled trials conducted in emergency care have demonstrated the efficacy of the PedAMINES app in reducing drug administration errors, there is a lack of evidence regarding its economic implications.
Objective:
This study aims to evaluate the cost-effectiveness of implementing the PedAMINES app for 4 emergency drugs: epinephrine, norepinephrine, dopamine, and midazolam.
Methods:
The economic evaluation was conducted by combining hospital data from 2019, previous trial outcomes, information extracted from existing literature, and PedAMINES maintenance costs. The cost per avoided medication error was calculated, along with the number of administrations needed to achieve a positive return on investment. Subsequently, Monte Carlo simulations were used to identify the key parameters contributing to result uncertainty.
Results:
The study revealed the number of preventable errors per administration for the 4 examined drugs: 0.513 for epinephrine, 0.484 for norepinephrine, 0.500 for dopamine, and 0.671 for midazolam. The cost-effectiveness ratios per ADE prevented were computed as follows: US $4808 for epinephrine, US $9705 for norepinephrine, US $6957 for dopamine, and US $2074 for midazolam. Accounting for the economic impact of ADEs, the analysis estimated that 16 administrations of epinephrine, 17 of norepinephrine and dopamine, and 13 of midazolam would be required to attain a positive return on investment. This corresponds to roughly one-third of the annual administrations at a major university hospital in Switzerland. The primary factors influencing the uncertainty in the estimated cost per ADE include the cost of maintenance of the app, the likelihood of an ADE resulting from an administration error, and the frequency of underdosing in the trial's control group.
Conclusions:
A dedicated mobile app presents an economically viable solution to alleviate the health and economic burden of drug administration errors in in-hospital pediatric emergency care. The widespread adoption of this app is advocated to pool costs and extend the benefits on a national scale in Switzerland.
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