Variable cost per dose of preparing and administering small-volume cephalosporin admixtures. Veterans Administration...

The nondrug variable cost per dose of preparing and administering small-volume cephalosporin admixtures was evaluated at six Veterans Administration Medical Centers (VAMCs). Six VAMCs that had pharmacy-operated i.v. admixture programs that routinely prepared small-volume injections (SVIs) were studied. The preparation methods observed and analyzed included individual and batch preparation of SVIs using partial-fill polyvinyl chloride containers and manufacturers' prefilled bottles. The administration methods studied were limited to dose administration using indwelling intermittent injection sites or SVI administration sets connected to primary continuous inline infusion sets. In estimating costs, average personnel salaries and material costs were used. The impact of changes in dosing frequency on nondrug costs was calculated using the estimated nondrug variable cost per dose and data gathered from i.v. profiles. Each VAMC was visited and observed for two or three days. The average nondrug variable cost per dose of the six VAMCs was $2.95. The nondrug variable cost per dose for the 16 different combinations of preparation and administration methods ranged from $1.01 to $6.11. The proportion of this cost attributable to materials ranged from 34% to 77% and was at least 64% in 14 of the combinations studied. Examples of projected savings resulting from reduced dosing frequency are given. Substantial savings in preparation and administration costs can occur if the frequency of administration is reduced through the use of longer-acting i.v. cephalosporins administered as SVIs. Total costs, however, will be less only if the higher cost of a day's supply of a longer-acting drug does not offset the savings achieved with less frequent administration.