Maviglia Saverio M, Yoo Jane Y, Franz Calvin, Featherstone Erica, Churchill William, Bates David W, Gandhi Tejal K, Poon Eric G
Brigham and Women's Hospital, Harvard Medical School, Wellesley, MA 02481, USA.
Arch Intern Med. 2007 Apr 23;167(8):788-94. doi: 10.1001/archinte.167.8.788.
Bar coding can reduce hospital pharmacy dispensing errors, but it is unclear if the benefits of this technology justify its costs. The purpose of this study was to assess the costs and benefits and determine the return on investment at the institutional level for implementing a pharmacy bar code system.
We performed a cost-benefit analysis of a bar code-assisted medication-dispensing system within a large, academic, nonprofit tertiary care hospital pharmacy. We took the implementing hospital's perspective for a 5-year horizon. The primary outcome was the net financial cost and benefit after 5 years. The secondary outcome was the time until total benefits equaled total costs. Single-variable, 2-variable, and multiple-variable Monte Carlo sensitivity analyses were performed to test the stability of the outcomes.
In inflation- and time value-adjusted 2005 dollars, total costs during 5 years were $2.24 million ($1.31 million in 1-time costs during the initial 3.5 years and $342 000 per year in recurring costs starting in year 3). The primary benefit was a decrease in adverse drug events from dispensing errors (517 events annually), resulting in an annual savings of $2.20 million. The net benefit after 5 years was $3.49 million. The break-even point for the hospital's investment occurred within 1 year after becoming fully operational. A net benefit was achieved within 10 years under almost all sensitivity scenarios. In the Monte Carlo simulation, the net benefit during 5 years was $3.2 million (95% confidence interval, -$1.2 million to $12.1 million), and the break-even point for return on investment occurred after 51 months (95% confidence interval, 30 to 180 months).
Implementation of a bar code-assisted medication-dispensing system in hospital pharmacies can result in a positive financial return on investment for the health care organization.
条形码可减少医院药房配药错误，但该技术的益处是否能证明其成本合理尚不清楚。本研究的目的是评估成本和效益，并确定在机构层面实施药房条形码系统的投资回报率。
我们对一家大型学术性非营利性三级护理医院药房内的条形码辅助配药系统进行了成本效益分析。我们从实施该系统的医院角度进行了为期5年的展望。主要结果是5年后的净财务成本和效益。次要结果是总效益等于总成本所需的时间。进行了单变量、双变量和多变量蒙特卡洛敏感性分析，以检验结果的稳定性。
以2005年经通胀和时间价值调整后的美元计算，5年期间的总成本为224万美元（最初3.5年的一次性成本为131万美元，从第3年开始每年的经常性成本为34.2万美元）。主要益处是配药错误导致的药物不良事件减少（每年517起事件），每年节省220万美元。5年后的净效益为349万美元。医院投资的收支平衡点在全面投入运营后1年内实现。在几乎所有敏感性情景下，10年内都实现了净效益。在蒙特卡洛模拟中，5年期间的净效益为320万美元（95%置信区间，-120万美元至1210万美元），投资回报率的收支平衡点在51个月后出现（95%置信区间，30至180个月）。
在医院药房实施条形码辅助配药系统可为医疗机构带来正的财务投资回报。
