Economic evidence for licensed ready-to-administer intravenous products compared with standard vials and ampoules: a...

Injectable medicines represent a significant proportion of the annual medicines expenditure of the NHS in England, totalling £7 billion ($9.4 billion, €8.0 billion) in 2023. This represents approximately 70% of hospital medicines spending and includes essential treatments delivered at the point of care, such as chemotherapy; clinical trial drugs; and intravenous nutrition. Licensed ready-to-administer injectable products are manufactured and labelled for immediate use, eliminating the need for preparation or dilution by clinical staff, thereby enhancing efficiency and reducing risks. Despite the recognised benefits of ready-to-administer products for safety and productivity, most NHS hospitals favour traditional vials due to lower initial acquisition costs.

We searched for studies evaluating the clinical or economic impact of ready-to-administer intravenous medications in hospital settings. Grey literature from NHS and UK government sources was also reviewed. Inclusion criteria comprised English language studies assessing cost; waste; preparation time; or medication errors associated with ready-to-administer use.

Sixteen studies were included in the review. Ready-to-administer products generally reduced preparation errors, drug wastage and preparation time, but variability in outcome measures and their definitions precluded meta-analysis. Evidence suggesting fewer adverse drug events and workflow interruptions derived mainly from observational studies and surrogate outcomes. Economic evaluations indicated potential savings from avoided errors, reduced waste and staff time, though estimates were context-specific and assumption-dependent. Overall, the risk of bias varied across studies and the predominance of small, single-centre, non-randomised designs limits generalisability.

Licensed ready-to-administer products are associated with fewer preparation errors, shorter preparation times and reduced drug waste, with plausible economic benefits. The certainty of this conclusion is limited by heterogeneous, largely non-randomised designs and context-specific costs. Evidence specific to the UK is sparse. Multicentre studies with standardised outcomes and robust micro-costing are needed to define clinical impact, budget impact and implementation requirements.