Creation and implementation of a preparation billing tool at Henri Mondor Hospital

Introduction
In 2022, the hospital pharmacy at Henri Mondor hospital produced 930 magistral preparations (MP) and 82 batches of hospital preparations (HP). 110 (11%) were retroceded or subcontracted, representing 3,600 units (96% HP, 4% MP). The absence of an official or recent pricing system for these preparations has led to the application of an arbitrary "manufacturing and packaging" fixed price for their invoicing. The aim of this project was to draw up a precise costing grid for these preparations, enabling the most accurate invoicing.

Materials & method
A survey was carried out by observing how preparations were made and reading production sheets. Pharmaceutical Raw Materials (PRM), packaging, consumables, equipment, reusable materials and operator times were recorded, along with the corresponding prices, using local market prices, quotes and staff hourly rates. Prices for PRM and finished product control were calculated using an activity indicator already in place at the control laboratory. The grid was tested on 10 retroceded or subcontracted preparations (6 HP dry forms, 4 MP semi-solid forms).

Results
This information was compiled in an Excel spreadsheet, taking into account the number of units produced per preparation and the number of preparations produced per year. The tool created enables a unit price to be calculated by entering the preparation information and the time spent by the various parties involved in making the preparation. The time, cost and technicality of each control analysis were quoted separately: the price was calculated by time plus a multiplying coefficient according to the technicality rating. The control price was calculated by entering the quantity and type of analyses performed. The rates obtained showed a median unit price for a HP well below that of a MP (€2.4 (min: €0.6; max: €17.4) and €78.1 (min: €39.5; max: €94) respectively), as the number of units prepared dilutes the cost of personnel and control (on average 38% and 22% of the preparation cost). The total cost was estimated at €15330 in 2022, compared with €8861 invoiced via the old grids.

Discussion-Conclusion
This work has enabled us to create an easy-to-use tool for calculating preparation prices. The prices calculated appear to be coherent with similar work already carried out. However, it was not possible to obtain the cost of premises and control equipment, so the final cost is slightly underestimated. The calculation of preparation manufacturing costs and invoicing rates will enable us to obtain reimbursements in line with actual costs, and to make the most of the human effort and investment in equipment made by the hospital pharmacy at Henri Mondor hospital.

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