Economic impact of error prevention in the production of injectable chemotherapies

H. Mockly-Postal, S. Perrin, V. Nerich, C. Fleck, A. Fousseret, A. Bossu, X. Fierobe, B. Maître, C. Fagnoni Legat, S. Limat Pôle Pharmaceutique, CHU, Besançon, France

Objective

Evaluation of the economic impact of the prevention of production errors in a context of a computerised and protocol-controlled circuit of injectable chemotherapies.

Methodology

A cost/benefit analysis was performed to compare 2 strategies: with verification and without verification of the production stage from the hospital’s viewpoint. The data compiled prospectively over a period from 15/02/2010 to 31/05/2010 were fed into a decision tree. The errors were identified at the time of production (declaration), at the time of verification of the finished product (according to a standardised monitoring protocol) and at the point of care (declaration). The costs recorded included the costs in personnel, in drugs and in medical devices. The benefits were calculated in hospital days avoided and the cost of the Homogenous Care Group according to a retrospective costing by a committee of experts. The results are expressed in the number of hospital days avoided, the total benefit and the cost/benefit ratio.

Results

A total of 12,450 preparations were made over a period of 11 weeks. The verifications made it possible to avoid 11 hospital days. The total benefit and the cost/benefit ratio are nil. The cost/benefit ratio of the non-compliances recorded at the time of production is 1.40 (198 €/141 €). On the other hand, for the other 2 points of data collection, the ratios are 2€/0€ and 5€/0€ respectively. A Monte-Carlo sensitivity analysis made it possible to verify the robustness of the results. At the 90% threshold of acceptability, the total benefit is 0 €.

Discussion - Conclusion

Verification of the production stages shows no cost benefit. However, it is complementary to the safety chain of the chemotherapy circuit, already made safe to a large extent by the upstream application of protocols and the automatic print-out of production sheets, and remains essential to ensure complete mastery of the production process.

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