Economic Evaluation of a Robotic Chemotherapy Compounding System and its Service Expansion to Network Hospitals in Thailand

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This study evaluated the cost-effectiveness of a locally developed robotic chemotherapy compounding system at Udon Thani Cancer Hospital and its expansion to network hospitals in Thailand. Methods: A descriptive study with economic evaluation was conducted, including cost‒benefitanalysis, unit cost analysis, and break‒even analysis from both provider and health system perspectives. Data were collected during the fiscal year 2023. Direct and indirect costs were analyzed, and clinical outcomes were tracked. A one-way sensitivity analysis was used to assess the robustness of the results. Results: Robotic preparation had a higher per-dose cost (THB 538) than manual preparation did (THB 250) but provided economic benefits, including labor and training savings, improved pharmaceutical care, and error reduction. The incremental benefit‒cost ratio (IBCR) was 1.566. When expanded to network hospitals, robotic compounding and delivery had an IBCR of 3.018, indicating strong cost-effectiveness. Conclusions: Robotic chemotherapy compounding systems show potential economic and operational benefits, particularly in regional settings. These findings provide initial evidence to inform policy considerations under Thailand’s Cancer Service Plan, though further research is needed to confirm long-term cost-effectiveness. Robotic compounding Chemotherapy preparation Economic evaluation Cost‒benefit analysis Thailand Health system perspective Background Cancer remains a leading cause of death in Thailand, with its incidence rising steadily and posing significant public health and economic challenges[ 1 ]. In response, the Ministry of Public Health launched the Cancer Service Plan, a nationwide initiative aimed at ensuring equitable access to cancer screening and treatment[ 2 ]. This includes a focus on strengthening infrastructure, human resources, and treatment technologies across provincial and regional cancer centers. Chemotherapy remains a core modality in cancer treatment and is widely used across nearly all cancer types. However, the handling of cytotoxic agents, particularly during compounding and intravenous administration, presents considerable occupational hazards. Healthcare workers involved in these tasks, including pharmacists and nurses, face chronic exposure risks that may result in chromosomal abnormalities[ 3 ], reproductive health complications [ 4 ], and psychological stress associated with high-risk, precision-dependent procedures. Improper handling may also lead to environmental contamination, necessitating stringent procedures for waste disposal and the use of personal protective equipment. In Thailand, pharmacists bear primary responsibility for compounding chemotherapy drugs, especially intravenous preparations. These tasks often involve manual techniques under biological safety cabinets, requiring extensive training and certification. Nevertheless, risks remain, and human error can lead to serious consequences. Meta-analyses have reported preparation-related errors in 8–20% of intravenous chemotherapy administrations [ 5 , 6 ], further compounding risks to both patient safety and staff well-being. To improve safety, accuracy, and operational efficiency, robotic chemotherapy compounding systems have been increasingly adopted in high-income countries. These systems integrate electronic prescribing platforms, use barcode verification and gravimetric control for real-time dose accuracy, and significantly reduce direct human handling of hazardous agents [ 7 , 8 ]. Numerous studies have demonstrated that robotic systems reduce exposure risk, increase compounding precision, and improve overall workflow efficiency[ 9 – 11 ]. Meta-analyses confirm lower failure rates and reduced contamination, especially in infusion bags [ 12 – 14 ], although cost savings in labor remain variable. Despite these advantages, the adoption of robotic systems in low- and middle-income countries is limited by high capital costs and technological dependency on imports. To address these challenges, Udon Thani Cancer Hospital, in collaboration with King Mongkut’s Institute of Technology Ladkrabang, developed Thailand’s first domestically manufactured robotic chemotherapy compounding system[ 15 ]. The robot is tailored to fit local clinical contexts compatible with packaging and materials commonly used in Thai hospitals and offers comparable performance to international systems at significantly lower cost. It has been successfully implemented for internal hospital use and has been extended to deliver chemotherapy to network hospitals within a 200-kilometer radius or under a three-hour transport window. This innovation represents a paradigm shift in localized healthcare technology development. However, the system still requires substantial investment and a reliable delivery infrastructure to serve external facilities. Therefore, a comprehensive economic evaluation is necessary to assess the cost-effectiveness of the robotic system compared with manual compounding. This study aims to evaluate both the use of the system within Udon Thani Cancer Hospital and its service expansion to surrounding hospitals. The evaluation includes unit cost analysis, delivery cost estimation, break-even point analysis, and cost‒benefit comparisons to inform evidence-based policymaking and future investment in scalable oncology care solutions in Thailand. Methods Study design This descriptive study incorporated an economic evaluation to assess the cost-effectiveness of a robotic chemotherapy preparation system compared with conventional manual preparation performed by hospital pharmacists. The evaluation employed both cost‒benefit analysis (CBA) and unit cost analysis via the standard costing method. A break-even point analysis was additionally performed to determine the minimum volume of chemotherapy preparations required for financial viability of the robotic system. The economic evaluation was conducted from both the healthcare provider perspective and the broader health system perspective. Study setting and period The study was conducted at Udon Thani Cancer Hospital, a regional cancer center located in northeastern Thailand. The evaluation was based on data collected during the fiscal year 2023 (October 2022–September 2023). In addition, service expansion scenarios for network hospitals under the cancer service plan were analyzed. Data collection and sources This study collected both direct and indirect costs related to chemotherapy preparation and delivery via a robotic compounding system, as well as conventional manual preparation by pharmacists. Direct costs Direct costs included labor costs, material costs, and capital costs: Labor cost (LC) : Labor expenses were derived from hospital payroll data at Udon Thani Cancer Hospital and affiliated network hospitals. The costs included salaries, wages, position allowances, overtime payments, healthcare benefits, child support, and educational subsidies. Labor cost allocations were calculated on the basis of the proportion of time spent on chemotherapy preparation activities. Material cost (MC) : Material costs were divided into two categories: Medical supplies obtained from the hospital’s procurement division, allocated on the basis of actual utilization and calculated on the basis of the annual average unit price. Utilities such as electricity and water are allocated on the basis of the room area and number of staff, respectively. For electricity, usage was estimated according to the area of the compounding rooms (150 m² for manual preparation and 75.3 m² for robotic preparation). Chemotherapy drug costs were excluded. Capital cost (CC) : Capital costs included buildings and equipment related to drug preparation and distribution systems. Building costs were based on construction costs amortized over the expected life span and allocated proportionally to space usage. Equipment depreciation was calculated on the basis of acquisition cost and useful life, with allocations according to usage patterns. Indirect costs Indirect costs included overhead expenses related to supporting departments. These costs were estimated using a 10% markup rate on total direct costs, representing the overhead cost allocation. Data collection instruments Instruments were used to collect data: cost data collection forms for robotic preparation and manual pharmacist preparation (capital, labor, and material costs). Output recording forms for production volume, number of deliveries, and delivery cycles; medication error tracking forms (prescribing, preparation, dispensing, and administration); and waste management forms (types and volume of hazardous waste from chemotherapy, and disposal cost). The semi-structured interview guide used in this study was specifically developed by the research team to collect data on clinical and operational outcomes related to robotic chemotherapy compounding. An English version of the interview guide is provided as Supplementary File 1. The cost data collection form used for the economic evaluation is provided as Supplementary File 2. Data collection methods Data related to direct/indirect costs and resource utilization were gathered from internal hospital records. Interviews with personnel involved in compounding and delivery. Operational reports, including production logs, inventory records, transportation logs, and medication error reports. Data analysis Descriptive statistics were used to summarize key variables, including percentages, means, and standard deviations. Unit cost analysis : The unit cost per chemotherapy dose or service was calculated by dividing total costs by total output. Break-even point analysis : The break-even point for robotic chemotherapy compounding and delivery services to network hospitals was calculated via the formula: Incremental benefit-to-cost ratio (IBCR) : The economic benefit of the robotic system was assessed using the IBCR, calculated as: Results Unit Cost and Break-even Point of Robotic Chemotherapy Compounding An economic analysis was conducted from the healthcare provider’s perspective to estimate the unit cost and break-even point of robotic chemotherapy compounding in comparison to manual compounding by hospital pharmacists. The analysis encompassed labor, material, and capital costs and followed a standard costing method for fiscal year 2023. All costs are reported in Thai Baht (THB). Direct Costs Labor costs for manual compounding amounted to THB 1,952,475.56 (77.8%), whereas labor costs for robotic compounding were THB 446,698.88 (22.2%). Additional labor costs incurred by supporting departments contributed approximately THB 41,406.24. Material costs , excluding chemotherapy drugs, were THB 1,460,444.85 for manual compounding and THB 296,966.10 for robotic compounding. Capital Costs Annual capital depreciation for manual compounding was THB 811,757.84, which included the cleanroom facilities, compounding isolators, and associated calibration costs. For robotic compounding, annual capital depreciation was THB 1,108,081.39, encompassing the robotic system (AYA Robotic), necessary facility upgrades, HEPA filters, and yearly calibration. Total Costs After applying a 10% overhead allocation, the total cost of manual compounding was THB 5,070,377.18, whereas for robotic compounding it was THB 2,245,002.94. In terms of cost composition, manual compounding expenses consisted of approximately 42% labor, 38% materials, and 20% capital, whereas the costs for robotic compounding were about 22% labor, 22% materials, and 56% capital. Table 1 provides a comparison of unit costs between manual and robotic compounding. In fiscal year 2023, a total of 20,310 doses were prepared manually, compared to 4,173 doses prepared using the robotic system. The unit cost was THB 250 per dose for manual compounding, compared to THB 538 per dose for robotic compounding. Table 1 Unit Cost Comparison Item Manual Compounding (THB) Robotic Compounding (THB) Labor cost 1,952,475.56 446,698.88 Material cost 1,460,444.85 296,966.10 Capital cost 811,757.84 1,108,081.39 Indirect cost (10%) 845,699.93 393,256.57 Total cost 5,070,377.18 2,245,002.94 Output (doses) 20,310 4,173 Unit cost per dose 250 538 Robotic Compounding and Delivery to Network Hospitals An extended analysis was performed to include the delivery of compounded chemotherapy to network hospitals. Transport-related costs for this delivery system amounted to THB 69,417.74 in total, which covers vehicle depreciation and fuel expenses (calculated at THB 4 per km for 116 round trips of 125 km each). In fiscal year 2023, the robotic compounding system prepared and delivered 834 doses to network hospitals. The transportation cost alone corresponded to approximately THB 83.23 per dose. When the robotic compounding costs are proportionally allocated to this subset of output (which represents about 20% of the total doses prepared by the robotic system), the combined cost of compounding and delivering these 834 doses was THB 518,418.28. Break-even Analysis Table 2 presents the break-even point for the robotic compounding system at Udon Thani Cancer Hospital under different scenarios. Under a reimbursement rate of THB 160 per dose for chemotherapy preparation, and treating labor and capital expenses as fixed costs while treating material costs as variable (estimated at THB 118.08 per dose), the break-even volume for the robotic compounding system was calculated to be approximately 41,802 doses. In contrast, for robotic compounding with delivery to network hospitals (assuming a charge rate of THB 200 per dose), the break-even point was reduced to around 5,122 doses. Table 2 Break-even Analysis Service Type Reimbursement Rate (THB) Unit Variable Cost (THB) Fixed Cost (THB) Break-even Point (doses) Robotic preparation (in-house) 160 118.08 2,245,002.94 41,802 Robotic compounding with delivery to network 200 201.31 518,418.28 5,122 Clinical Outcomes Between August 2022 and September 2023, a total of 12,500 chemotherapy prescriptions were reviewed as part of the clinical service evaluation. During this period, 52 medication error incidents were identified, corresponding to an overall error rate of 4.16 per 1,000 prescriptions or 2.56 per 1,000 doses. Errors associated with manual compounding accounted for 9 incidents (0.72 per 1,000 prescriptions), the majority of which involved the use of incorrect diluents or solvents. In contrast, robotic compounding was associated with only one error, which was unrelated to the compounding process itself (e.g., labeling or administrative error), highlighting the enhanced reliability of the robotic system. In addition, gravimetric analysis conducted on 1,221 compounded doses produced by the robotic system confirmed a median deviation of 0% from the target volume, indicating exceptionally high accuracy and consistency. This represents a significant improvement over manual preparation techniques and underscores the robotic system’s contribution to medication safety, as summarized in Table 3 . Table 3 Clinical Outcomes Parameter Manual Compounding Robotic Compounding Medication errors (per 1,000 prescriptions) 0.72 0.08 (1 event total) Median volume deviation Not reported 0% Gravimetric accuracy (number of doses tested) Not reported 1,221 doses Economic Benefits Table 4 summarizes the estimated economic benefits associated with the implementation of robotic chemotherapy compounding. These benefits were categorized into three main components: Table 4 Economic benefits summary Benefit Type Estimated Value (THB) Labor cost savings 1,337,374.58 Training cost savings 360,000.00 Pharmaceutical care benefit 184,750.00 Total benefit 1,882,124.58 Labor Cost Savings The replacement of manual preparation with robotic compounding resulted in substantial reductions in labor demand. Based on the calculated decrease in man-days required for preparation activities, the estimated labor cost savings amounted to THB 1,337,374.58. This reflects improved operational efficiency and resource allocation. Training Cost Savings With the adoption of robotic systems, the need for manual compounding training among pharmacists is significantly reduced. It was estimated that training costs for 12 pharmacists—each requiring THB 30,000 in training expenses—could be avoided, resulting in a total savings of THB 360,000. This not only reduces short-term training expenditures but also minimizes the long-term burden of maintaining competency in manual techniques. Economic Value of Improved Pharmaceutical Care The use of robotic compounding allows for the reallocation of pharmacists’ time from drug preparation to direct patient care. This shift enhances the quality of pharmaceutical services. Based on the number of prescriptions managed (12,500 cases) and an estimated economic value of pharmaceutical interventions at THB 14.78 per case, the total benefit from improved pharmaceutical care was calculated at THB 184,750. This reflects the broader health system gains from optimizing the role of clinical pharmacists. Together, these benefits yield a total economic gain of THB 1,882,124.58, as detailed in Table 4 , supporting the value proposition of robotic compounding beyond direct cost comparisons. Cost-benefit Analysis of Robotic Chemotherapy Compounding at Udon Thani Cancer Hospital and Its Service Expansion to Network Hospitals The total cost of robotic chemotherapy compounding at Udon Thani Cancer Hospital was THB 2,245,002.94, equivalent to THB 538 per dose. In comparison, the total cost of manual preparation was THB 5,070,377.18, or THB 250 per dose. Despite the higher unit cost, the robotic system yielded substantial economic benefits, including reductions in labor costs, training expenses, and enhanced clinical service efficiency. These benefits totaled THB 1,882,124.58 (THB 451 per dose). The incremental benefit-to-cost ratio (IBCR) for the robotic system was calculated at 1.566, indicating that the investment is economically justifiable and demonstrates favorable cost-effectiveness. From the broader health system perspective, the extension of robotic compounding services to network hospitals—through centralized preparation and delivery—resulted in a total cost of THB 518,095.58 (THB 621 per dose). In contrast, the conventional self-preparation approach at the network hospitals incurred a total cost of THB 317,754 (THB 381 per dose). However, when accounting for the total economic benefits—comprising savings from reduced preparation costs, decreased training requirements, improved pharmaceutical care, and lower hazardous waste disposal expenses (totaling THB 604,560)—the IBCR for the expanded service model was 3.018. This finding suggests a strong economic advantage and supports the value of centralized robotic compounding with delivery to affiliated facilities, as summarized in Table 5 . Table 5 Cost-benefit Analysis Summary Scenario Total Cost (THB) Cost per Dose (THB) Total Benefit (THB) IBCR Manual Preparation 5,070,377.18 250 - - Robotic Compounding 2,245,002.94 538 1882124.58 1.566 Self-preparation at Network Hospitals 317,754.00 381 - - Robotic Compounding with Delivery 518,095.58 621 604560.0 3.018 Discussion Economic evaluation of health technologies plays a critical role in guiding policy decisions, particularly for high-cost innovations that promise improved outcomes. Robotic chemotherapy compounding represents such a technology: although it requires substantial capital investment, it offers superior accuracy, enhanced staff safety, and the potential to reduce long-term operational costs. This study applied cost‒benefit analysis to compare robotic and manual chemotherapy preparation at Udon Thani Cancer Hospital. The cost‒benefit framework was appropriate for this evaluation, as it allowed monetary comparisons of both costs and benefits across alternatives. The results revealed that the incremental benefit‒cost ratio (IBCR) for robotic compounding compared with manual preparation was 1.566, whereas the IBCR for robotic compounding with delivery to network hospitals reached 3.055. These findings demonstrate the economic viability of robotic compounding, both in standalone and expanded service models. The unit cost analysis further revealed that manual compounding had a cost structure of 42:38:20 (labor cost:material cost:capital cost), whereas robotic compounding shifted this to 22:22:56, reflecting a reduction in labor costs and an increase in capital costs. This cost structure aligns with findings from previous international studies, which reported significant labor cost savings with robotic systems. Economic benefits included savings in labor and training costs, as well as increased pharmaceutical care. However, this study did not capture other potential benefits reported in the literature, such as reductions in medication errors, environmental contamination, occupational health risks, drug wastage, and improved institutional reputation or patient confidence in advanced healthcare technologies. A key limitation of this study was the reliance on estimated cost data from a network hospital (Nong Bua Lamphu Hospital), which may affect accuracy. Additionally, the analysis was conducted during the initial year of robotic implementation (fiscal year 2023), when the robotic system was not operating at full capacity. This resulted in a higher unit cost estimate. Sensitivity analysis projected that the unit cost would decrease from THB 538 to THB 381 in the following fiscal year and further to THB 187 under full capacity utilization. Economic evaluation of health technologies plays a critical role in guiding policy decisions, particularly for high-cost innovations that promise improved outcomes. Robotic chemotherapy compounding represents such a technology; although it requires substantial capital investment, it offers superior accuracy, enhanced staff safety, and the potential to reduce long-term operational costs [ 7 , 8 ]. This study applied cost‒benefit analysis to compare robotic and manual chemotherapy preparation at Udon Thani Cancer Hospital. The cost benefit framework was appropriate for this evaluation, as it allowed monetary comparisons of both costs and benefits across alternatives. The results revealed that the incremental benefit‒cost ratio (IBCR) for robotic compounding compared with manual preparation was 1.566, whereas the IBCR for robotic compounding with delivery to network hospitals reached 3.055. These findings demonstrate the economic viability of robotic compounding, both in standalone and expanded service models. The unit cost analysis further revealed that manual compounding had a cost structure of 42:38:20 (labor cost: material cost: capital cost), whereas robotic compounding shifted this to 22:22:56, reflecting a reduction in labor costs and an increase in capital costs. This cost structure aligns with findings from previous international studies, which reported significant labor cost savings with robotic systems[ 8 ]. The economic benefits of robotic compounding in this research include savings in labor and training costs, as well as increased pharmaceutical care. However, this study did not capture other potential benefits reported in the literature, such as reductions in medication errors, environmental contamination, occupational health risks, drug wastage, and improved institutional reputation or patient confidence in advanced healthcare technologies [ 7 , 8 ]. A key limitation of this study was the reliance on estimated cost data from a network hospital (Nong Bua Lamphu Hospital), which may affect accuracy. Additionally, the analysis was conducted during the initial year of robotic implementation (fiscal year 2023), when the robotic system was not operating at full capacity. This resulted in a higher unit cost estimate. Sensitivity analysis projected that the unit cost would decrease from THB 538 to THB 381 in the following fiscal year and further to THB 187 under full capacity utilization, which is consistent with the international trend of cost reduction through scale-up and efficiency gains. Conclusion The findings from this study suggest that robotic chemotherapy compounding systems have the potential to be economically justifiable compared to manual preparation, particularly when scaled for service delivery to network hospitals. While the robotic system demonstrated reductions in labor requirements and potential improvements in safety and accuracy, these benefits must be interpreted within the context of operational capacity and resource investment. The results provide preliminary support for the integration of locally developed robotic technologies into Thailand’s regional cancer service plans, but further research is needed to validate long-term sustainability, clinical outcomes, and system-wide impacts. This study has some limitations. The economic evaluation was conducted over a single fiscal year during the early implementation of the robotic system, which may not represent long-term performance. Cost estimates for the network hospital involved extrapolations due to limited local data. Additionally, benefits such as reduced occupational exposure and environmental contamination were not quantitatively assessed, and patient-level clinical outcomes were not analyzed. Further studies should investigate long-term impacts using multi-center data. Declarations Ethics approval and consent to participate This study was reviewed and approved by the Ethics Committee of Udon Thani Cancer Hospital (IRB Protocol No. UDCH_COA 014/2023, approval date: August 4, 2023). Written informed consent to participate was obtained from all participants prior to data collection. The study was conducted in full compliance with the ethical principles of the Declaration of Helsinki (2013 revision), as set forth by the World Medical Association. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions NS and SL conceptualized the study and designed the methodology. AL, KB, and PU collected and managed the data. ST provided clinical oversight and guidance. SL conducted the economic analysis and drafted the manuscript. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank the staff of Udon Thani Cancer Hospital and network hospitals for their collaboration and support during data collection and system implementation. Authors’ information Namfon Sribundit, Ph.D. Surasit Lochid-amnuay, Ph.D. Department of Health Consumer Protection and Pharmacy Administration, Faculty of Pharmacy, Silpakorn University Araya Lukanawonakul, M.Sc. in Pharmacy Kritiya Butthongkomvong, M.D. Patcharin Usa, M.P.H. Udon Thani Cancer Hospital Somchai Thanasitthichai, M.D. National Cancer Institute, Ramathibodi Medical School, Mahidol University References National Cancer Institute Thailand. Cancer in Thailand 2020. In.; 2020. 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Success of three robots. for preparing chemo drugs announced [ https://www.nationthailand.com/health-wellness/40043826] Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1Englishversionofthesemistructuredinterviewguideusedfordatacollectiononclinicalandoperationaloutcomes.docx Supplementary File 1. English version of the semi-structured interview guide used for data collection on clinical and operational outcomes related to robotic chemotherapy compounding. SupplementaryFile2.Costdatacollectionform.docx Supplementary File 2. Cost data collection form developed to capture direct and indirect costs associated with robotic and manual chemotherapy preparation, including labor, materials, capital investment, and overhead allocation. Cite Share Download PDF Status: Published Journal Publication published 30 Jul, 2025 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 18 Jun, 2025 Reviews received at journal 17 Jun, 2025 Reviews received at journal 25 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviewers agreed at journal 07 May, 2025 Reviewers invited by journal 04 May, 2025 Editor assigned by journal 04 May, 2025 Editor invited by journal 02 May, 2025 Submission checks completed at journal 30 Apr, 2025 First submitted to journal 30 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6494959","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":452059421,"identity":"528ee5d3-04cd-4697-84cf-acbe3b2d7b46","order_by":0,"name":"Namfon Sribundit","email":"","orcid":"","institution":"Silpakorn University","correspondingAuthor":false,"prefix":"","firstName":"Namfon","middleName":"","lastName":"Sribundit","suffix":""},{"id":452059423,"identity":"45ddce43-40e6-4c44-a45e-6c8c426fe673","order_by":1,"name":"Surasit Lochid-amnuay","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYBACPgYGNoYENjjfBsY4gFMLG5qWNCidQEALA0LLYSK0sDc/e/CgzC7aXCL5mQTDn/P2BgeYH35g/HEHtxaeY+YGCeeSc3fOSDOTYGy7nbjhAJuxBEPCM9xaJHLYJBLbmHM33EgAamm4nWBwgMEM6LDDhLTUA7WkfwM67BzQYezfiNFyGKglx0yCge0A44YDPARs4TlmJpFw7njuhjNvii0Y25ITZx7mKZZISMOthR8YYpI/yqpzNxxP33iD4Y+dPd/x9o0fPtjg1oIMWKT/gChmIE4gSgNQ7QciFY6CUTAKRsEIAwBpcFL97Rc68QAAAABJRU5ErkJggg==","orcid":"","institution":"Silpakorn University","correspondingAuthor":true,"prefix":"","firstName":"Surasit","middleName":"","lastName":"Lochid-amnuay","suffix":""},{"id":452059425,"identity":"776ef3cb-46e5-4b37-ae87-b3198000a92d","order_by":2,"name":"Araya Lukanawonakul","email":"","orcid":"","institution":"Udon Thani Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Araya","middleName":"","lastName":"Lukanawonakul","suffix":""},{"id":452059427,"identity":"09cee228-3ab0-4daa-b818-218d4e863560","order_by":3,"name":"Kritiya Butthongkomvong","email":"","orcid":"","institution":"Udon Thani Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kritiya","middleName":"","lastName":"Butthongkomvong","suffix":""},{"id":452059428,"identity":"7f716d29-8d1d-493c-817f-e9cb101db9b7","order_by":4,"name":"Patcharin Usa","email":"","orcid":"","institution":"Udon Thani Cancer Hospital","correspondingAuthor":false,"prefix":"","firstName":"Patcharin","middleName":"","lastName":"Usa","suffix":""},{"id":452059429,"identity":"541f28e3-dc7b-4a7a-aa03-a14366c7e184","order_by":5,"name":"Somchai Thanasitthichai","email":"","orcid":"","institution":"National Cancer Institute","correspondingAuthor":false,"prefix":"","firstName":"Somchai","middleName":"","lastName":"Thanasitthichai","suffix":""}],"badges":[],"createdAt":"2025-04-21 10:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6494959/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6494959/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-025-13186-7","type":"published","date":"2025-07-30T16:06:11+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88268437,"identity":"a1106b17-0698-41c1-ae71-d11eecb76be8","added_by":"auto","created_at":"2025-08-04 16:51:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":965928,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6494959/v1/a4eccf70-7e5d-467e-9f08-519faee6a450.pdf"},{"id":82017502,"identity":"7e4d51f1-6fa2-445f-84c0-40695928a26c","added_by":"auto","created_at":"2025-05-06 04:15:52","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":27934,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary File 1. English version of the semi-structured interview guide used for data collection on clinical and operational outcomes related to robotic chemotherapy compounding.\u003c/p\u003e","description":"","filename":"SupplementaryFile1Englishversionofthesemistructuredinterviewguideusedfordatacollectiononclinicalandoperationaloutcomes.docx","url":"https://assets-eu.researchsquare.com/files/rs-6494959/v1/751f8bbc0d47642e25a8669f.docx"},{"id":82016794,"identity":"c8efe34f-e9bf-47bc-9a5c-385f7fc6cdf8","added_by":"auto","created_at":"2025-05-06 04:07:52","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":39009,"visible":true,"origin":"","legend":"\u003cp\u003eSupplementary File 2. Cost data collection form developed to capture direct and indirect costs associated with robotic and manual chemotherapy preparation, including labor, materials, capital investment, and overhead allocation.\u003c/p\u003e","description":"","filename":"SupplementaryFile2.Costdatacollectionform.docx","url":"https://assets-eu.researchsquare.com/files/rs-6494959/v1/27dff9bad3db36a3014c43ae.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Economic Evaluation of a Robotic Chemotherapy Compounding System and its Service Expansion to Network Hospitals in Thailand","fulltext":[{"header":"Background","content":"\u003cp\u003eCancer remains a leading cause of death in Thailand, with its incidence rising steadily and posing significant public health and economic challenges[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In response, the Ministry of Public Health launched the Cancer Service Plan, a nationwide initiative aimed at ensuring equitable access to cancer screening and treatment[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This includes a focus on strengthening infrastructure, human resources, and treatment technologies across provincial and regional cancer centers.\u003c/p\u003e \u003cp\u003eChemotherapy remains a core modality in cancer treatment and is widely used across nearly all cancer types. However, the handling of cytotoxic agents, particularly during compounding and intravenous administration, presents considerable occupational hazards. Healthcare workers involved in these tasks, including pharmacists and nurses, face chronic exposure risks that may result in chromosomal abnormalities[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], reproductive health complications [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and psychological stress associated with high-risk, precision-dependent procedures. Improper handling may also lead to environmental contamination, necessitating stringent procedures for waste disposal and the use of personal protective equipment.\u003c/p\u003e \u003cp\u003eIn Thailand, pharmacists bear primary responsibility for compounding chemotherapy drugs, especially intravenous preparations. These tasks often involve manual techniques under biological safety cabinets, requiring extensive training and certification. Nevertheless, risks remain, and human error can lead to serious consequences. Meta-analyses have reported preparation-related errors in 8\u0026ndash;20% of intravenous chemotherapy administrations [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], further compounding risks to both patient safety and staff well-being.\u003c/p\u003e \u003cp\u003eTo improve safety, accuracy, and operational efficiency, robotic chemotherapy compounding systems have been increasingly adopted in high-income countries. These systems integrate electronic prescribing platforms, use barcode verification and gravimetric control for real-time dose accuracy, and significantly reduce direct human handling of hazardous agents [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Numerous studies have demonstrated that robotic systems reduce exposure risk, increase compounding precision, and improve overall workflow efficiency[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Meta-analyses confirm lower failure rates and reduced contamination, especially in infusion bags [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], although cost savings in labor remain variable.\u003c/p\u003e \u003cp\u003eDespite these advantages, the adoption of robotic systems in low- and middle-income countries is limited by high capital costs and technological dependency on imports. To address these challenges, Udon Thani Cancer Hospital, in collaboration with King Mongkut\u0026rsquo;s Institute of Technology Ladkrabang, developed Thailand\u0026rsquo;s first domestically manufactured robotic chemotherapy compounding system[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The robot is tailored to fit local clinical contexts compatible with packaging and materials commonly used in Thai hospitals and offers comparable performance to international systems at significantly lower cost. It has been successfully implemented for internal hospital use and has been extended to deliver chemotherapy to network hospitals within a 200-kilometer radius or under a three-hour transport window.\u003c/p\u003e \u003cp\u003eThis innovation represents a paradigm shift in localized healthcare technology development. However, the system still requires substantial investment and a reliable delivery infrastructure to serve external facilities. Therefore, a comprehensive economic evaluation is necessary to assess the cost-effectiveness of the robotic system compared with manual compounding. This study aims to evaluate both the use of the system within Udon Thani Cancer Hospital and its service expansion to surrounding hospitals. The evaluation includes unit cost analysis, delivery cost estimation, break-even point analysis, and cost‒benefit comparisons to inform evidence-based policymaking and future investment in scalable oncology care solutions in Thailand.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design\u003c/h2\u003e\n \u003cp\u003eThis descriptive study incorporated an economic evaluation to assess the cost-effectiveness of a robotic chemotherapy preparation system compared with conventional manual preparation performed by hospital pharmacists. The evaluation employed both cost‒benefit analysis (CBA) and unit cost analysis via the standard costing method. A break-even point analysis was additionally performed to determine the minimum volume of chemotherapy preparations required for financial viability of the robotic system. The economic evaluation was conducted from both the healthcare provider perspective and the broader health system perspective.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy setting and period\u003c/h3\u003e\n\u003cp\u003eThe study was conducted at Udon Thani Cancer Hospital, a regional cancer center located in northeastern Thailand. The evaluation was based on data collected during the fiscal year 2023 (October 2022\u0026ndash;September 2023). In addition, service expansion scenarios for network hospitals under the cancer service plan were analyzed.\u003c/p\u003e\n\u003ch3\u003eData collection and sources\u003c/h3\u003e\n\u003cp\u003eThis study collected both direct and indirect costs related to chemotherapy preparation and delivery via a robotic compounding system, as well as conventional manual preparation by pharmacists.\u003c/p\u003e\n\u003ch3\u003eDirect costs\u003c/h3\u003e\n\u003cp\u003eDirect costs included labor costs, material costs, and capital costs:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eLabor cost (LC)\u003c/strong\u003e: Labor expenses were derived from hospital payroll data at Udon Thani Cancer Hospital and affiliated network hospitals. The costs included salaries, wages, position allowances, overtime payments, healthcare benefits, child support, and educational subsidies. Labor cost allocations were calculated on the basis of the proportion of time spent on chemotherapy preparation activities.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eMaterial cost (MC)\u003c/strong\u003e: Material costs were divided into two categories:\u003c/p\u003e\n \u003col\u003e\n \u003cli\u003e\n \u003cp\u003eMedical supplies obtained from the hospital\u0026rsquo;s procurement division, allocated on the basis of actual utilization and calculated on the basis of the annual average unit price.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eUtilities such as electricity and water are allocated on the basis of the room area and number of staff, respectively. For electricity, usage was estimated according to the area of the compounding rooms (150 m\u0026sup2; for manual preparation and 75.3 m\u0026sup2; for robotic preparation). Chemotherapy drug costs were excluded.\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eCapital cost (CC)\u003c/strong\u003e: Capital costs included buildings and equipment related to drug preparation and distribution systems. Building costs were based on construction costs amortized over the expected life span and allocated proportionally to space usage. Equipment depreciation was calculated on the basis of acquisition cost and useful life, with allocations according to usage patterns.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eIndirect costs\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eIndirect costs included overhead expenses related to supporting departments. These costs were estimated using a 10% markup rate on total direct costs, representing the overhead cost allocation.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eData collection instruments\u003c/h2\u003e\n \u003cp\u003eInstruments were used to collect data: cost data collection forms for robotic preparation and manual pharmacist preparation (capital, labor, and material costs). Output recording forms for production volume, number of deliveries, and delivery cycles; medication error tracking forms (prescribing, preparation, dispensing, and administration); and waste management forms (types and volume of hazardous waste from chemotherapy, and disposal cost). The semi-structured interview guide used in this study was specifically developed by the research team to collect data on clinical and operational outcomes related to robotic chemotherapy compounding. An English version of the interview guide is provided as Supplementary File 1. The cost data collection form used for the economic evaluation is provided as Supplementary File 2.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eData collection methods\u003c/h3\u003e\n\u003cp\u003eData related to direct/indirect costs and resource utilization were gathered from internal hospital records. Interviews with personnel involved in compounding and delivery. Operational reports, including production logs, inventory records, transportation logs, and medication error reports.\u003c/p\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003eData analysis\u003c/h2\u003e\n \u003cp\u003eDescriptive statistics were used to summarize key variables, including percentages, means, and standard deviations.\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eUnit cost analysis\u003c/strong\u003e: The unit cost per chemotherapy dose or service was calculated by dividing total costs by total output.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eBreak-even point analysis\u003c/strong\u003e: The break-even point for robotic chemotherapy compounding and delivery services to network hospitals was calculated via the formula:\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cimg 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\" style=\"width: 636px;\"\u003e\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eIncremental benefit-to-cost ratio (IBCR)\u003c/strong\u003e: The economic benefit of the robotic system was assessed using the IBCR, calculated as:\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" style=\"width: 371px;\"\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eUnit Cost and Break-even Point of Robotic Chemotherapy Compounding\u003c/h2\u003e \u003cp\u003eAn economic analysis was conducted from the healthcare provider\u0026rsquo;s perspective to estimate the unit cost and break-even point of robotic chemotherapy compounding in comparison to manual compounding by hospital pharmacists. The analysis encompassed labor, material, and capital costs and followed a standard costing method for fiscal year 2023. All costs are reported in Thai Baht (THB).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDirect Costs\u003c/strong\u003e \u003cp\u003eLabor costs for manual compounding amounted to THB 1,952,475.56 (77.8%), whereas labor costs for robotic compounding were THB 446,698.88 (22.2%). Additional labor costs incurred by supporting departments contributed approximately THB 41,406.24. \u003cem\u003eMaterial costs\u003c/em\u003e, excluding chemotherapy drugs, were THB 1,460,444.85 for manual compounding and THB 296,966.10 for robotic compounding.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCapital Costs\u003c/strong\u003e \u003cp\u003eAnnual capital depreciation for manual compounding was THB 811,757.84, which included the cleanroom facilities, compounding isolators, and associated calibration costs. For robotic compounding, annual capital depreciation was THB 1,108,081.39, encompassing the robotic system (AYA Robotic), necessary facility upgrades, HEPA filters, and yearly calibration.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTotal Costs\u003c/strong\u003e \u003cp\u003eAfter applying a 10% overhead allocation, the total cost of manual compounding was THB 5,070,377.18, whereas for robotic compounding it was THB 2,245,002.94. In terms of cost composition, manual compounding expenses consisted of approximately 42% labor, 38% materials, and 20% capital, whereas the costs for robotic compounding were about 22% labor, 22% materials, and 56% capital. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides a comparison of unit costs between manual and robotic compounding. In fiscal year 2023, a total of 20,310 doses were prepared manually, compared to 4,173 doses prepared using the robotic system. The unit cost was THB 250 per dose for manual compounding, compared to THB 538 per dose for robotic compounding.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnit Cost Comparison\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManual Compounding (THB)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRobotic Compounding (THB)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabor cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,952,475.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e446,698.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaterial cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,460,444.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e296,966.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCapital cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e811,757.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,108,081.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndirect cost (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e845,699.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e393,256.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal cost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5,070,377.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,245,002.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutput (doses)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20,310\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4,173\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnit cost per dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e538\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eRobotic Compounding and Delivery to Network Hospitals\u003c/h2\u003e \u003cp\u003eAn extended analysis was performed to include the delivery of compounded chemotherapy to network hospitals. Transport-related costs for this delivery system amounted to THB 69,417.74 in total, which covers vehicle depreciation and fuel expenses (calculated at THB 4 per km for 116 round trips of 125 km each). In fiscal year 2023, the robotic compounding system prepared and delivered 834 doses to network hospitals. The transportation cost alone corresponded to approximately THB 83.23 per dose. When the robotic compounding costs are proportionally allocated to this subset of output (which represents about 20% of the total doses prepared by the robotic system), the combined cost of compounding and delivering these 834 doses was THB 518,418.28.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBreak-even Analysis\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the break-even point for the robotic compounding system at Udon Thani Cancer Hospital under different scenarios. Under a reimbursement rate of THB 160 per dose for chemotherapy preparation, and treating labor and capital expenses as fixed costs while treating material costs as variable (estimated at THB 118.08 per dose), the break-even volume for the robotic compounding system was calculated to be approximately 41,802 doses. In contrast, for robotic compounding with delivery to network hospitals (assuming a charge rate of THB 200 per dose), the break-even point was reduced to around 5,122 doses.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBreak-even Analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eService Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReimbursement Rate (THB)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnit Variable Cost (THB)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFixed Cost (THB)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreak-even Point (doses)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRobotic preparation (in-house)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,245,002.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e41,802\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRobotic compounding with delivery to network\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e201.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e518,418.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5,122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eClinical Outcomes\u003c/h2\u003e \u003cp\u003eBetween August 2022 and September 2023, a total of 12,500 chemotherapy prescriptions were reviewed as part of the clinical service evaluation. During this period, 52 medication error incidents were identified, corresponding to an overall error rate of 4.16 per 1,000 prescriptions or 2.56 per 1,000 doses. Errors associated with manual compounding accounted for 9 incidents (0.72 per 1,000 prescriptions), the majority of which involved the use of incorrect diluents or solvents. In contrast, robotic compounding was associated with only one error, which was unrelated to the compounding process itself (e.g., labeling or administrative error), highlighting the enhanced reliability of the robotic system. In addition, gravimetric analysis conducted on 1,221 compounded doses produced by the robotic system confirmed a median deviation of 0% from the target volume, indicating exceptionally high accuracy and consistency. This represents a significant improvement over manual preparation techniques and underscores the robotic system\u0026rsquo;s contribution to medication safety, as summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManual Compounding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRobotic Compounding\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication errors (per 1,000 prescriptions)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.08 (1 event total)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian volume deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGravimetric accuracy (number of doses tested)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,221 doses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eEconomic Benefits\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e summarizes the estimated economic benefits associated with the implementation of robotic chemotherapy compounding. These benefits were categorized into three main components:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEconomic benefits summary\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBenefit Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEstimated Value (THB)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabor cost savings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,337,374.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraining cost savings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e360,000.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePharmaceutical care benefit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e184,750.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal benefit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,882,124.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLabor Cost Savings\u003c/strong\u003e \u003cp\u003eThe replacement of manual preparation with robotic compounding resulted in substantial reductions in labor demand. Based on the calculated decrease in man-days required for preparation activities, the estimated labor cost savings amounted to THB 1,337,374.58. This reflects improved operational efficiency and resource allocation.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTraining Cost Savings\u003c/strong\u003e \u003cp\u003eWith the adoption of robotic systems, the need for manual compounding training among pharmacists is significantly reduced. It was estimated that training costs for 12 pharmacists\u0026mdash;each requiring THB 30,000 in training expenses\u0026mdash;could be avoided, resulting in a total savings of THB 360,000. This not only reduces short-term training expenditures but also minimizes the long-term burden of maintaining competency in manual techniques.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEconomic Value of Improved Pharmaceutical Care\u003c/strong\u003e \u003cp\u003eThe use of robotic compounding allows for the reallocation of pharmacists\u0026rsquo; time from drug preparation to direct patient care. This shift enhances the quality of pharmaceutical services. Based on the number of prescriptions managed (12,500 cases) and an estimated economic value of pharmaceutical interventions at THB 14.78 per case, the total benefit from improved pharmaceutical care was calculated at THB 184,750. This reflects the broader health system gains from optimizing the role of clinical pharmacists.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eTogether, these benefits yield a total economic gain of THB 1,882,124.58, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, supporting the value proposition of robotic compounding beyond direct cost comparisons.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCost-benefit Analysis of Robotic Chemotherapy Compounding at Udon Thani Cancer Hospital and Its Service Expansion to Network Hospitals\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe total cost of robotic chemotherapy compounding at Udon Thani Cancer Hospital was THB 2,245,002.94, equivalent to THB 538 per dose. In comparison, the total cost of manual preparation was THB 5,070,377.18, or THB 250 per dose. Despite the higher unit cost, the robotic system yielded substantial economic benefits, including reductions in labor costs, training expenses, and enhanced clinical service efficiency. These benefits totaled THB 1,882,124.58 (THB 451 per dose). The incremental benefit-to-cost ratio (IBCR) for the robotic system was calculated at 1.566, indicating that the investment is economically justifiable and demonstrates favorable cost-effectiveness.\u003c/p\u003e \u003cp\u003eFrom the broader health system perspective, the extension of robotic compounding services to network hospitals\u0026mdash;through centralized preparation and delivery\u0026mdash;resulted in a total cost of THB 518,095.58 (THB 621 per dose). In contrast, the conventional self-preparation approach at the network hospitals incurred a total cost of THB 317,754 (THB 381 per dose). However, when accounting for the total economic benefits\u0026mdash;comprising savings from reduced preparation costs, decreased training requirements, improved pharmaceutical care, and lower hazardous waste disposal expenses (totaling THB 604,560)\u0026mdash;the IBCR for the expanded service model was 3.018. This finding suggests a strong economic advantage and supports the value of centralized robotic compounding with delivery to affiliated facilities, as summarized in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCost-benefit Analysis Summary\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScenario\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal Cost (THB)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCost per Dose (THB)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal Benefit (THB)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIBCR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManual Preparation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5,070,377.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRobotic Compounding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,245,002.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1882124.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.566\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-preparation at Network Hospitals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e317,754.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRobotic Compounding with Delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e518,095.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e621\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e604560.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eEconomic evaluation of health technologies plays a critical role in guiding policy decisions, particularly for high-cost innovations that promise improved outcomes. Robotic chemotherapy compounding represents such a technology: although it requires substantial capital investment, it offers superior accuracy, enhanced staff safety, and the potential to reduce long-term operational costs. This study applied cost‒benefit analysis to compare robotic and manual chemotherapy preparation at Udon Thani Cancer Hospital. The cost‒benefit framework was appropriate for this evaluation, as it allowed monetary comparisons of both costs and benefits across alternatives. The results revealed that the incremental benefit‒cost ratio (IBCR) for robotic compounding compared with manual preparation was 1.566, whereas the IBCR for robotic compounding with delivery to network hospitals reached 3.055. These findings demonstrate the economic viability of robotic compounding, both in standalone and expanded service models.\u003c/p\u003e \u003cp\u003eThe unit cost analysis further revealed that manual compounding had a cost structure of 42:38:20 (labor cost:material cost:capital cost), whereas robotic compounding shifted this to 22:22:56, reflecting a reduction in labor costs and an increase in capital costs. This cost structure aligns with findings from previous international studies, which reported significant labor cost savings with robotic systems. Economic benefits included savings in labor and training costs, as well as increased pharmaceutical care. However, this study did not capture other potential benefits reported in the literature, such as reductions in medication errors, environmental contamination, occupational health risks, drug wastage, and improved institutional reputation or patient confidence in advanced healthcare technologies.\u003c/p\u003e \u003cp\u003eA key limitation of this study was the reliance on estimated cost data from a network hospital (Nong Bua Lamphu Hospital), which may affect accuracy. Additionally, the analysis was conducted during the initial year of robotic implementation (fiscal year 2023), when the robotic system was not operating at full capacity. This resulted in a higher unit cost estimate. Sensitivity analysis projected that the unit cost would decrease from THB 538 to THB 381 in the following fiscal year and further to THB 187 under full capacity utilization.\u003c/p\u003e \u003cp\u003eEconomic evaluation of health technologies plays a critical role in guiding policy decisions, particularly for high-cost innovations that promise improved outcomes. Robotic chemotherapy compounding represents such a technology; although it requires substantial capital investment, it offers superior accuracy, enhanced staff safety, and the potential to reduce long-term operational costs [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This study applied cost‒benefit analysis to compare robotic and manual chemotherapy preparation at Udon Thani Cancer Hospital. The cost benefit framework was appropriate for this evaluation, as it allowed monetary comparisons of both costs and benefits across alternatives. The results revealed that the incremental benefit‒cost ratio (IBCR) for robotic compounding compared with manual preparation was 1.566, whereas the IBCR for robotic compounding with delivery to network hospitals reached 3.055. These findings demonstrate the economic viability of robotic compounding, both in standalone and expanded service models.\u003c/p\u003e \u003cp\u003eThe unit cost analysis further revealed that manual compounding had a cost structure of 42:38:20 (labor cost: material cost: capital cost), whereas robotic compounding shifted this to 22:22:56, reflecting a reduction in labor costs and an increase in capital costs. This cost structure aligns with findings from previous international studies, which reported significant labor cost savings with robotic systems[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The economic benefits of robotic compounding in this research include savings in labor and training costs, as well as increased pharmaceutical care. However, this study did not capture other potential benefits reported in the literature, such as reductions in medication errors, environmental contamination, occupational health risks, drug wastage, and improved institutional reputation or patient confidence in advanced healthcare technologies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA key limitation of this study was the reliance on estimated cost data from a network hospital (Nong Bua Lamphu Hospital), which may affect accuracy. Additionally, the analysis was conducted during the initial year of robotic implementation (fiscal year 2023), when the robotic system was not operating at full capacity. This resulted in a higher unit cost estimate. Sensitivity analysis projected that the unit cost would decrease from THB 538 to THB 381 in the following fiscal year and further to THB 187 under full capacity utilization, which is consistent with the international trend of cost reduction through scale-up and efficiency gains.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings from this study suggest that robotic chemotherapy compounding systems have the potential to be economically justifiable compared to manual preparation, particularly when scaled for service delivery to network hospitals. While the robotic system demonstrated reductions in labor requirements and potential improvements in safety and accuracy, these benefits must be interpreted within the context of operational capacity and resource investment. The results provide preliminary support for the integration of locally developed robotic technologies into Thailand\u0026rsquo;s regional cancer service plans, but further research is needed to validate long-term sustainability, clinical outcomes, and system-wide impacts. This study has some limitations. The economic evaluation was conducted over a single fiscal year during the early implementation of the robotic system, which may not represent long-term performance. Cost estimates for the network hospital involved extrapolations due to limited local data. Additionally, benefits such as reduced occupational exposure and environmental contamination were not quantitatively assessed, and patient-level clinical outcomes were not analyzed. Further studies should investigate long-term impacts using multi-center data.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study was reviewed and approved by the Ethics Committee of Udon Thani Cancer Hospital (IRB Protocol No. UDCH_COA 014/2023, approval date: August 4, 2023). Written informed consent to participate was obtained from all participants prior to data collection. The study was conducted in full compliance with the ethical principles of the Declaration of Helsinki (2013 revision), as set forth by the World Medical Association.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNS and SL conceptualized the study and designed the methodology. AL, KB, and PU collected and managed the data. ST provided clinical oversight and guidance. SL conducted the economic analysis and drafted the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors would like to thank the staff of Udon Thani Cancer Hospital and network hospitals for their collaboration and support during data collection and system implementation.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNamfon Sribundit, Ph.D.\u003cbr\u003e\u0026nbsp;Surasit Lochid-amnuay, Ph.D.\u003cbr\u003e\u0026nbsp;Department of Health Consumer Protection and Pharmacy Administration, Faculty of Pharmacy, Silpakorn University\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Araya Lukanawonakul, M.Sc. in Pharmacy\u003cbr\u003e\u0026nbsp;Kritiya Butthongkomvong, M.D.\u003cbr\u003e\u0026nbsp;Patcharin Usa, M.P.H.\u003cbr\u003e\u0026nbsp;Udon Thani Cancer Hospital\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;Somchai Thanasitthichai, M.D.\u003cbr\u003e\u0026nbsp;National Cancer Institute, Ramathibodi Medical School, Mahidol University\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNational Cancer Institute Thailand. Cancer in Thailand 2020. In.; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Cancer Prevention and Control Planning committee DoMS, Ministry of Public Health. National cancer prevention and control plan (2018\u0026ndash;2022). Bangkok: Department of Medical Services, Ministry of Public Health; 2018.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoussel C, Witt KL, Shaw PB, Connor TH. Meta-analysis of chromosomal aberrations as a biomarker of exposure in healthcare workers occupationally exposed to antineoplastic drugs. Mutat Research/Reviews Mutat Res. 2019;781:207\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConnor TH, Lawson CC, Polovich M, McDiarmid MA. Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings: a review of the evidence. J Occup Environ Med. 2014;56(9):901\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFord CD, Killebrew J, Fugitt P, Jacobsen J, Prystas EM. Study of medication errors on a community hospital oncology ward. J Oncol Pract. 2006;2(4):149\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlas A, Silay K, Akinci S, Dede D, AKINCI M, ŞENDUR M, Cubukcu E, Coskun H, Degirmenci M, UTKAN G. Medication errors in chemotherapy preparation and administration: a survey conducted among oncology nurses in Turkey. Asian Pac J Cancer Prev 2015, 16(5).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMasini C, Nanni O, Antaridi S, Gallegati D, Marri M, Paolucci D, Minguzzi M, Altini M. Automated preparation of chemotherapy: quality improvement and economic sustainability. Am J Health-System Pharm. 2014;71(7):579\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRiestra AC, L\u0026oacute;pez-Cabezas C, Jobard M, Campo M, Tam\u0026eacute;s MJ, Mar\u0026iacute;n AM, Brandely-Piat ML, Carcelero-San Mart\u0026iacute;n E, Batista R, Cajaraville G. Robotic chemotherapy compounding: a multicenter productivity approach. J Oncol Pharm Pract. 2022;28(2):362\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCapilli M, Enrico F, Federici M, Comandone T. Increasing pharmacy productivity and reducing medication turnaround times in an Italian comprehensive cancer center by implementing robotic chemotherapy drugs compounding. J Oncol Pharm Pract. 2022;28(2):353\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIwamoto T, Morikawa T, Hioki M, Sudo H, Paolucci D, Okuda M. Performance evaluation of the compounding robot, APOTECAchemo, for injectable anticancer drugs in a Japanese hospital. J Pharm Health Care Sci. 2017;3:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShin S, Koo J, Kim SW, Kim S, Hong SY, Lee E. Evaluation of robotic systems on cytotoxic drug preparation: a systematic review and meta-analysis. Medicina. 2023;59(3):431.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBatson S, Mitchell SA, Lau D, Canobbio M, de Goede A, Singh I, Loesch U. Automated compounding technology and workflow solutions for the preparation of chemotherapy: a systematic review. Eur J Hosp Pharm. 2020;27(6):330\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeng L, Ni X. Intravenous compounding robots in pharmacy intravenous admixture services: a health technology assessment. 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeger AC, Churchill WW, Keohane CA, Belisle CD, Wong ST, Sylvester KW, Chesnick MA, Burdick E, Wien MF, Cotugno MC, et al. Impact of robotic antineoplastic preparation on safety, workflow, and costs. J Oncol Pract. 2012;8(6):344\u0026ndash;9. 341 p following 349.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuccess of three robots. for preparing chemo drugs announced [\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nationthailand.com/health-wellness/40043826]\u003c/span\u003e\u003cspan address=\"https://www.nationthailand.com/health-wellness/40043826]\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Robotic compounding, Chemotherapy preparation, Economic evaluation, Cost‒benefit analysis, Thailand, Health system perspective","lastPublishedDoi":"10.21203/rs.3.rs-6494959/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6494959/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eRobotic systems for chemotherapy preparation offer increased accuracy and staff safety but require high capital investment. This study evaluated the cost-effectiveness of a locally developed robotic chemotherapy compounding system at Udon Thani Cancer Hospital and its expansion to network hospitals in Thailand.\u003cbr\u003e\n\u003cstrong\u003eMethods:\u003c/strong\u003e A descriptive study with economic evaluation was conducted, including cost‒benefitanalysis, unit cost analysis, and break‒even analysis from both provider and health system perspectives. Data were collected during the fiscal year 2023. Direct and indirect costs were analyzed, and clinical outcomes were tracked. A one-way sensitivity analysis was used to assess the robustness of the results.\u003cbr\u003e\n\u003cstrong\u003eResults:\u003c/strong\u003e Robotic preparation had a higher per-dose cost (THB 538) than manual preparation did (THB 250) but provided economic benefits, including labor and training savings, improved pharmaceutical care, and error reduction. The incremental benefit‒cost ratio (IBCR) was 1.566. When expanded to network hospitals, robotic compounding and delivery had an IBCR of 3.018, indicating strong cost-effectiveness.\u003cbr\u003e\n\u003cstrong\u003eConclusions:\u003c/strong\u003e Robotic chemotherapy compounding systems show potential economic and operational benefits, particularly in regional settings. These findings provide initial evidence to inform policy considerations under Thailand’s Cancer Service Plan, though further research is needed to confirm long-term cost-effectiveness.\u003c/p\u003e","manuscriptTitle":"Economic Evaluation of a Robotic Chemotherapy Compounding System and its Service Expansion to Network Hospitals in Thailand","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-06 03:59:48","doi":"10.21203/rs.3.rs-6494959/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-18T06:25:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-17T10:44:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-25T15:46:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"323064470766609064694628093233959893394","date":"2025-05-20T02:00:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282726891709933174501120192687546834970","date":"2025-05-07T15:26:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-05T00:45:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-04T23:59:34+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-02T09:44:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-30T13:52:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-04-30T13:51:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14af85eb-b66c-45ec-8ba3-f981ae8c600f","owner":[],"postedDate":"May 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-04T16:46:07+00:00","versionOfRecord":{"articleIdentity":"rs-6494959","link":"https://doi.org/10.1186/s12913-025-13186-7","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2025-07-30 16:06:11","publishedOnDateReadable":"July 30th, 2025"},"versionCreatedAt":"2025-05-06 03:59:48","video":"","vorDoi":"10.1186/s12913-025-13186-7","vorDoiUrl":"https://doi.org/10.1186/s12913-025-13186-7","workflowStages":[]},"version":"v1","identity":"rs-6494959","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6494959","identity":"rs-6494959","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}