集中式自动化单元剂量配发与条形码辅助用药管理在医院环境中的成本效益。

Cost-effectiveness of central automated unit dose dispensing with barcode-assisted medication administration in a hospital setting.

机构信息

Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, P.O. Box 2040, 3000 CA, the Netherlands.

Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, P.O. Box 2040, 3000 CA, the Netherlands; Department of Intensive Care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, P.O. Box 2040, 3000 CA, the Netherlands.

出版信息

Res Social Adm Pharm. 2022 Nov;18(11):3980-3987. doi: 10.1016/j.sapharm.2022.07.006. Epub 2022 Jul 13.

DOI:10.1016/j.sapharm.2022.07.006

PMID:35853809

Abstract

BACKGROUND

Central automated unit dose dispensing (cADD) with barcode-assisted medication administration (BCMA) has been shown to reduce medication administration errors (MAEs). Little is known about the cost-effectiveness of this intervention.

OBJECTIVE

To estimate the cost-effectiveness of cADD with BCMA compared to usual care.

METHODS

An economic evaluation was conducted alongside a prospective before-and-after effectiveness study in a Dutch university hospital. The primary effect measure was the difference between the rate of MAEs before and after implementation of cADD with BCMA, obtained by disguised observation in six clinical wards and subsequent extrapolation to the entire hospital. The cost-analysis was conducted from a hospital perspective with a 12-month incremental costing approach. The total costs covered the pharmaceutical service, nurse medication handling, wastage, and materials related to cADD. The primary outcome was the cost-effectiveness ratio expressed as costs per avoided MAE, obtained by dividing the annual incremental costs by the number of avoided MAEs. The secondary outcome was the cost-effectiveness ratio expressed as costs per avoided potentially harmful MAE (i.e. MAEs with the potential to cause harm).

RESULTS

The intervention was associated with an absolute MAE reduction of 4.5% and a reduction of 2.7% for potentially harmful MAEs. Based on 2,260,870 administered medications in the entire hospital annually, a total of 102,210 MAEs and 59,830 potentially harmful MAEs were estimated to be avoided. The intervention was associated with an increased incremental cost of €1,808,600 annually. The cost-effectiveness ratio was €17.69 per avoided MAE and €30.23 per avoided potentially harmful MAE.

CONCLUSIONS

The implementation of cADD with BCMA was associated with a reduced rate of medication errors, including harmful ones, at higher overall costs. The costs per avoided error are relatively low, and therefore, this intervention could be an important strategy to improve patient safety in hospitals.

摘要

背景

带条形码辅助用药管理（BCMA）的中央自动化单位剂量配药（cADD）已被证明可减少用药错误（MAE）。对于这种干预措施的成本效益，我们知之甚少。

目的

评估带 BCMA 的 cADD 与常规护理相比的成本效益。

方法

在荷兰一家大学医院进行的前瞻性前后对照效果研究的同时进行了经济评估。主要效果衡量标准是通过在六个临床病房进行伪装观察后，实施带 BCMA 的 cADD 前后 MAE 发生率的差异，并将其外推至整个医院。成本分析从医院角度进行，采用 12 个月增量成本法。总成本涵盖了药房服务、护士用药处理、浪费以及与 cADD 相关的材料。主要结果是表示每避免一次 MAE 的成本效益比，即通过将年度增量成本除以避免的 MAE 数来获得。次要结果是表示每避免一次潜在有害 MAE（即有可能造成伤害的 MAE）的成本效益比。

结果

该干预措施与 MAE 减少 4.5%和潜在有害 MAE 减少 2.7%相关。基于每年整个医院管理的 2,260,870 种药物，估计可避免 102,210 次 MAE 和 59,830 次潜在有害 MAE。干预措施每年增加 1808600 欧元的增量成本。成本效益比为每避免一次 MAE 花费 17.69 欧元，每避免一次潜在有害 MAE 花费 30.23 欧元。