药房重新分发未使用药物的成本是多少？一项微观成本核算研究。
What does it cost to redispense unused medications in the pharmacy? A micro-costing study.
作者信息
Bekker Charlotte L, Gardarsdottir Helga, Egberts Antoine C G, Molenaar Hendrik A, Bouvy Marcel L, van den Bemt Bart J F, Hövels Anke M
机构信息
Department of Pharmacy, Sint Maartenskliniek, Hengstdal 3, 6574, NA, Nijmegen, the Netherlands.
Department of Clinical Pharmacy, Division Laboratories and Pharmacy, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands.
出版信息
BMC Health Serv Res. 2019 Apr 24;19(1):243. doi: 10.1186/s12913-019-4065-6.
BACKGROUND
Redispensing unused medications that have been returned to outpatient pharmacies by patients may reduce waste and healthcare costs. However, little is known regarding the extra costs associated with this process, nor the price level of medications for which this is economically beneficial. The objective of this study was to assess costs associated with redispensing unused medications in the pharmacy and the price level at which redispensing becomes cost-beneficial.
METHODS
A micro-costing study was conducted in four Dutch outpatient pharmacies for medications requiring room-temperature storage and requiring refrigeration. First, the pharmacy's necessary additional process steps and resources for redispensing were identified. Second, time required for each process step was simulated. Third, required resources were quantified by calculating labour, purchasing and overhead costs. Lastly, a model with different scenarios was constructed to calculate the price of a medication package at which redispensing becomes cost-beneficial.
RESULTS
Three main additional process steps for redispensing were identified: (1) pack medications with product quality indicators before dispensing, (2) assess quality of medications returned to the pharmacy (temperature storage, package integrity, expiry date) and (3a) restock medications fulfilling quality criteria or (3b) dispose of medications not fulfilling criteria. Total time required for all steps up to restock one medication package was on average 5.3 (SD ±0.3) and 6.8 (SD ±0.3) minutes for medications stored at room-temperature and under refrigeration, respectively, and associated costs were €5.54 and €7.61. Similar outcomes were found if a medication package would ultimately be disposed of. The price level primarily depended upon the proportion of dispensed packages returned unused to the pharmacy and fulfilling the quality criteria: if 5% is returned, of which 60% fulfils quality criteria, the price level was €101 per package for medications requiring room-temperature storage and €215 per package for those requiring refrigeration. However, if 10% is returned, of which 60% fulfils the quality criteria, the price level decreases to €53 and €109, respectively (arbitrary proportions).
CONCLUSIONS
Redispensing unused medications in the pharmacy is at least cost-beneficial if applied to expensive medications.
背景
重新调配患者退回门诊药房的未使用药物可能会减少浪费和医疗成本。然而，对于这一过程的额外成本以及在此过程中经济上有利可图的药物价格水平，人们知之甚少。本研究的目的是评估药房重新调配未使用药物的相关成本以及重新调配变得具有成本效益的价格水平。
方法
在荷兰的四家门诊药房针对需要室温储存和需要冷藏的药物进行了微观成本研究。首先，确定药房重新调配所需的额外流程步骤和资源。其次，模拟每个流程步骤所需的时间。第三，通过计算劳动力、采购和间接费用来量化所需资源。最后，构建一个具有不同情景的模型，以计算重新调配变得具有成本效益时的药物包装价格。
结果
确定了重新调配的三个主要额外流程步骤：（1）在调配前用产品质量指标包装药物，（2）评估退回药房的药物质量（温度储存、包装完整性、有效期），以及（3a）重新储存符合质量标准的药物或（3b）处置不符合标准的药物。重新储存一个药物包装的所有步骤平均所需时间，对于室温储存的药物为5.3（标准差±0.3）分钟，对于冷藏药物为6.8（标准差±0.3）分钟，相关成本分别为5.54欧元和7.61欧元。如果一个药物包装最终被处置，也发现了类似的结果。价格水平主要取决于未使用退回药房且符合质量标准的调配包装比例：如果5%被退回，其中60%符合质量标准，对于需要室温储存的药物，价格水平为每包装101欧元，对于需要冷藏的药物为每包装215欧元。然而，如果10%被退回，其中60%符合质量标准，价格水平分别降至53欧元和109欧元（任意比例）。
结论
如果应用于昂贵药物，在药房重新调配未使用药物至少具有成本效益。
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