Cost-effectiveness of pharmacy automation in hospital settings: systematic review

Medication errors in hospital pharmacies are still a major source of patient injury and healthcare expenditure globally. There has been a growing trend of implementing pharmacy automation technologies to improve the efficiency of work processes and minimise errors. However, there is a lack of evidence on the cost-effectiveness of these technologies. The objective of this systematic review was to assess the cost-effectiveness of pharmacy automation technologies such as automated dispensing cabinets (ADCs), robotic dispensing systems, automated compounding systems, barcode-assisted medication administration (BCMA) and unit-dose dispensing systems (UDDS) compared with traditional manual dispensing systems in inpatient and outpatient hospital pharmacy settings. Literature searches were performed using PubMed, Scopus, ScienceDirect and Google Scholar on 11 January 2026. The search terms were developed using Boolean operators and key words for pharmacy automation and economic evaluation. Articles were independently screened by two authors using Covidence software and any disagreements were resolved by consensus. The articles were selected based on predefined inclusion and exclusion criteria, focusing on cost-effectiveness outcomes in hospital pharmacy settings. The findings were qualitatively synthesised. A total of 613 articles were screened for title and abstract, and 7 of 118 full-text articles were selected based on the inclusion criteria. The included articles assessed various automation technologies such as ADCs, robots, UDDS, BCMA and LED-guided picking systems in hospital settings in Taiwan, Germany, the Netherlands, Singapore, Denmark and Brazil. Cost-effectiveness analysis showed large error reduction rates, with incremental cost-effectiveness ratios ranging from €2.01 to €386 per error prevented, and large efficiency gains, including time savings of up to 25.68 min per patient and equivalent to 11.7 full-time equivalent nurses. Automation reduced clinical, procedural and potentially harmful errors in comparison to manual systems, thereby supporting better patient safety and efficiency. Pharmacy automation technologies are highly cost-effective and efficient compared with manual dispensing systems. These technologies reduce errors, improve efficiency and can also provide cost savings, thereby providing rationale for their use as a strategy for optimising hospital pharmacy operations.