Creating an evidence-based economic model for prefilled parenteral medication delivery in the hospital setting

ABSTRACT Objectives Prefilled syringes (PFS) may offer clinical and economic advantages to conventional parenteral medication delivery methods (vials and ampoules). The benefits of converting from vials and ampoules to PFS have been elucidated in previous drug-specific economic models; however, these models have limited generalizability to different drugs, health care settings and other countries. This study aims to (1) present a comprehensive economic model to assess the impact of switching from vials to PFS delivery, and (2) illustrate the model’s utility by highlighting important features of shifting from vials to PFS through two case studies. Methods The economic model estimates the potential benefit of switching to PFS associated with four key outcomes: preventable adverse drug events (pADE), preparation time, unused drug, and cost of supplies. Model reference values were derived from existing peer-reviewed literature sources. The user inputs specific information related to the department, drug, and dose of interest can change reference values. Two hypothetical case studies are presented to showcase model utility. The first concerns a cardiac intensive care unit in the United Kingdom administering 30 doses of 1mg/10mL atropine/day. The second concerns a COVID-19 intensive care unit in France that administers 30 doses of 10mg/25mL ephedrine/day. Results Total cost savings per hospital per year, associated with reductions in pADEs, unused drugs, drug cost and cost of supplies were £34,829 for the atropine example and €108,565 for the ephedrine example. Annual preparation time decreased by 371 and 234 hours in the atropine and ephedrine examples, respectively. Conclusions The model provides a generalizable framework with customizable inputs, giving hospitals a comprehensive view of the clinical and economic value of adopting PFS. Despite increased costs per dose with PFS, the hypothetical case studies showed notable reductions in medication preparation time and a net budget savings owing to fewer pADEs and reduced drug wastage. KEY MESSAGES Globally, most parenteral medications are supplied via injection with medication dispensed from vials and ampoules, despite evidence that such formats result in unused drug, increase risk of preventable adverse drug events, significant hospital staff time to prepare and use of extra supplies. Prefilled syringes address the shortcomings of these conventional parenteral medication delivery methods, with benefits for patients, healthcare delivery systems, and hospitals. A novel economic model was developed to estimate the holistic budget impact of switching from vials and/or ampoules to prefilled syringe medication delivery formats for acute care hospital settings. Results: from two hypothetical case studies illustrate an overall cost offset despite higher prices of ready-to-administer formats with prefilled syringes compared to conventional delivery methods.