Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.
J Med Internet Res. 2024 Oct 25;26:e52077. doi: 10.2196/52077.
The administration of drugs in pediatric emergency care is a time-consuming process and is associated with a higher occurrence of medication errors compared with adult care. This is attributed to the intricacies of administration, which involve calculating doses based on the child's weight or age. To mitigate the occurrence of adverse drug events (ADEs), the PedAMINES (Pediatric Accurate Medication in Emergency Situations; Geneva University Hospitals) mobile app has been developed. This app offers a step-by-step guide for preparing and administering pediatric drugs during emergency interventions by automating the dose calculation process. Although previous simulation-based randomized controlled trials conducted in emergency care have demonstrated the efficacy of the PedAMINES app in reducing drug administration errors, there is a lack of evidence regarding its economic implications.
This study aims to evaluate the cost-effectiveness of implementing the PedAMINES app for 4 emergency drugs: epinephrine, norepinephrine, dopamine, and midazolam.
The economic evaluation was conducted by combining hospital data from 2019, previous trial outcomes, information extracted from existing literature, and PedAMINES maintenance costs. The cost per avoided medication error was calculated, along with the number of administrations needed to achieve a positive return on investment. Subsequently, Monte Carlo simulations were used to identify the key parameters contributing to result uncertainty.
The study revealed the number of preventable errors per administration for the 4 examined drugs: 0.513 for epinephrine, 0.484 for norepinephrine, 0.500 for dopamine, and 0.671 for midazolam. The cost-effectiveness ratios per ADE prevented were computed as follows: US $4808 for epinephrine, US $9705 for norepinephrine, US $6957 for dopamine, and US $2074 for midazolam. Accounting for the economic impact of ADEs, the analysis estimated that 16 administrations of epinephrine, 17 of norepinephrine and dopamine, and 13 of midazolam would be required to attain a positive return on investment. This corresponds to roughly one-third of the annual administrations at a major university hospital in Switzerland. The primary factors influencing the uncertainty in the estimated cost per ADE include the cost of maintenance of the app, the likelihood of an ADE resulting from an administration error, and the frequency of underdosing in the trial's control group.
A dedicated mobile app presents an economically viable solution to alleviate the health and economic burden of drug administration errors in in-hospital pediatric emergency care. The widespread adoption of this app is advocated to pool costs and extend the benefits on a national scale in Switzerland.
在儿科急救护理中，药物管理是一个耗时的过程，与成人护理相比，更容易发生用药错误。这归因于给药的复杂性，包括根据儿童体重或年龄计算剂量。为了减少不良药物事件（ADE）的发生，开发了 PedAMINES（儿科紧急情况下准确用药；日内瓦大学医院）移动应用程序。该应用程序通过自动计算剂量，为急救干预期间准备和管理儿科药物提供了逐步指导。尽管之前在急救护理中进行的基于模拟的随机对照试验已经证明了 PedAMINES 应用程序在减少药物给药错误方面的有效性，但缺乏关于其经济影响的证据。
本研究旨在评估为 4 种急救药物（肾上腺素、去甲肾上腺素、多巴胺和咪达唑仑）实施 PedAMINES 应用程序的成本效益。
经济评估结合了 2019 年的医院数据、先前试验结果、从现有文献中提取的信息和 PedAMINES 维护成本。计算了每避免一次用药错误的成本，以及实现投资回报所需的给药次数。随后，使用蒙特卡罗模拟确定导致结果不确定性的关键参数。
研究揭示了 4 种检查药物每次给药可预防的错误数量：肾上腺素为 0.513，去甲肾上腺素为 0.484，多巴胺为 0.500，咪达唑仑为 0.671。每预防一次 ADE 的成本效益比计算如下：肾上腺素为 4808 美元，去甲肾上腺素为 9705 美元，多巴胺为 6957 美元，咪达唑仑为 2074 美元。考虑到 ADE 的经济影响，分析估计需要进行 16 次肾上腺素给药、17 次去甲肾上腺素和多巴胺给药以及 13 次咪达唑仑给药，才能实现投资回报。这相当于瑞士一家主要大学医院每年给药量的三分之一左右。影响估计的每例 ADE 成本不确定性的主要因素包括应用程序维护成本、给药错误导致 ADE 的可能性以及试验对照组中剂量不足的频率。
专门的移动应用程序为减轻医院内儿科急救护理中药物给药错误的健康和经济负担提供了具有成本效益的解决方案。倡导广泛采用该应用程序，以在瑞士全国范围内分摊成本并扩大效益。
