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      A Cost-Effectiveness Study Comparing Ready-to-Administer and Traditional Vial-and-Syringe Method for Opioids

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          Abstract

          Objective

          The purpose of this study was to develop a cost-effectiveness model for manufacturer-prepared prefilled ready-to-administer (RTA) syringe products versus the traditional vial-and-syringe administration of intravenous (IV) opioids.

          Methods

          Cost parameters included cost of manufacturer-prepared prefilled RTA syringe product, traditional vial and syringe, drug preparation, drug administration, drug waste, and severity of error. Effectiveness endpoint included number of preparation and administration errors in each comparator arm. Simple decision tree was used, and incremental cost-effectiveness ratio (ICER) was calculated as the reduction in the incremental errors per observation with RTA compared with traditional vial-and-syringe method. One-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA) were conducted to test the robustness of the model. TreeAge Pro software was used to create and analyze the decision model. All the cost parameters were converted to USD 2021.

          Results

          Base-case analysis showed that the cost of the RTA arm was lower by $182.61 and the number of errors in the RTA arm was lower by 94%, compared with the traditional vial-and-syringe arm. The manufacturer-prepared prefilled RTA syringe product was found to be cost-effective with an incremental savings of $22,554 per additional error avoided. Sensitivity analysis showed that ICER value was most sensitive to the probability of errors; however, the results were robust in showing that RTA is the preferred cost-effective option, when both the costs and effectiveness parameters were varied substantially.

          Conclusion

          This economic evaluation  analyzed costs of using manufacturer-prepared prefilled RTA syringe product IV opioids and incremental benefits in terms of reduced errors, adverse events, and their associated costs. Manufacturer-prepared prefilled RTA syringe product was found to be cost-effective, demonstrating cost savings by reduction in the error rates. Integrating and adopting RTA syringe products within a health system could play an important role in improving care, building efficiency, increasing patient safety, and saving money.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s40122-022-00402-z.

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          Most cited references28

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          The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group.

          To assess the additional resource utilization associated with an adverse drug event (ADE). Nested case-control study within a prospective cohort study. The cohort included 4108 admissions to a stratified random sample of 11 medical and surgical units in 2 tertiary-care hospitals over a 6-month period. Cases were patients with an ADE, and the control for each case was the patient on the same unit as the case with the most similar pre-event length of stay. Postevent length of stay and total costs. Incidents were detected by self-report stimulated by nurses and pharmacists and by daily chart review, and were classified as to whether they represented ADEs. Information on length of stay and charges was obtained from billing data, and costs were estimated by multiplying components of charges times hospital-specific ratios of costs to charges. During the study period, there were 247 ADEs among 207 admissions. After outliers and multiple episodes were excluded, there were 190 ADEs, of which 60 were preventable. In paired regression analyses adjusting for multiple factors, including severity, comorbidity, and case mix, the additional length of stay associated with an ADE was 2.2 days (P=.04), and the increase in cost associated with an ADE was $3244 (P=.04). For preventable ADEs, the increases were 4.6 days in length of stay (P=.03) and $5857 in total cost (P=.07). After adjusting for our sampling strategy, the estimated postevent costs attributable to an ADE were $2595 for all ADEs and $4685 for preventable ADEs. Based on these costs and data about the incidence of ADEs, we estimate that the annual costs attributable to all ADEs and preventable ADEs for a 700-bed teaching hospital are $5.6 million and $2.8 million, respectively. The substantial costs of ADEs to hospitals justify investment in efforts to prevent these events. Moreover, these estimates are conservative because they do not include the costs of injuries to patients or malpractice costs.
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            Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands.

            Medication-related problems that lead to hospitalization have been the subject of many studies, many of which were limited to 1 hospital or lacked patient follow-up. Furthermore, little information exists on potential risk factors associated with preventable medication-related hospitalizations. A prospective multicenter study was conducted to determine the frequency and patient outcomes of medication-related hospital admissions. A case-control design was used to determine risk factors for potentially preventable admissions. All unplanned admissions in 21 hospitals were assessed during 40 days. Controls were patients admitted for elective surgery. Cases and controls were followed up until hospital discharge. The frequency of medication-related hospital admissions, potential preventability, and outcomes were assessed. For potentially preventable medication-related admissions, risk factors were identified in the case-control study. Almost 13,000 unplanned admissions were screened, of which 714 (5.6%) were medication related. Almost half (46.5%) of these admissions were potentially preventable, resulting in 332 case patients matched with 332 controls. Outcomes were favorable in most patients. The main determinants of preventable medication-related hospital admissions were impaired cognition (odds ratio, 11.9; 95% confidence interval, 3.9-36.3), 4 or more comorbidities (8.1; 3.1-21.7), dependent living situation (3.0; 1.4-6.5), impaired renal function (2.6; 1.6-4.2), nonadherence to medication regimen (2.3; 1.4-3.8), and polypharmacy (2.7; 1.6-4.4). Adverse drug events are an important cause of hospitalizations, and almost half are potentially preventable. The identified risk factors provide a starting point for preventing medication-related hospital admissions.
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              Recommendations for Reporting Cost-effectiveness Analyses

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                Author and article information

                Contributors
                parora@butler.edu
                Journal
                Pain Ther
                Pain Ther
                Pain and Therapy
                Springer Healthcare (Cheshire )
                2193-8237
                2193-651X
                10 June 2022
                10 June 2022
                September 2022
                : 11
                : 3
                : 937-950
                Affiliations
                [1 ]GRID grid.253419.8, ISNI 0000 0000 8596 9494, College of Pharmacy and Health Sciences, , Butler University, ; 4600 Sunset Ave, Indianapolis, IN 46208 USA
                [2 ]GRID grid.253419.8, ISNI 0000 0000 8596 9494, College of Pharmacy and Health Sciences, , Butler University, ; 4600 Sunset Ave, Indianapolis, IN 46208 USA
                [3 ]GRID grid.253419.8, ISNI 0000 0000 8596 9494, College of Pharmacy and Health Sciences, , Butler University, ; 4600 Sunset Ave, Indianapolis, IN 46208 USA
                Author information
                http://orcid.org/0000-0002-7057-9033
                Article
                402
                10.1007/s40122-022-00402-z
                9314479
                35687249
                7229c673-273c-4b51-acd5-dcf44fb09bf6
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 8 April 2022
                : 26 May 2022
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100017530, Fresenius Kabi;
                Categories
                Original Research
                Custom metadata
                © The Author(s) 2022

                ready-to-administer,prefilled syringe,cost-effectiveness analysis,medication errors,opioids

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