Prospective Assessment of the Economic Implications of Automating Chemotherapy Preparation in a Comprehensive Cancer Center

Objective
This study aimed to evaluate the economic implications of implementing an APOTECAchemo robot in a Comprehensive Cancer Center (CLCC) that conducts over 45,000 preparations annually within the framework of restructuring the Hospital Pharmacy Unit and expanding outpatient services planned for 2026.

Methods
A prospective economic analysis was conducted in collaboration with the CLCC financial management and medical information departments. Two scenarios were analyzed: a "with robot" scenario (robot plus two double-station isolators) and a "without robot" scenario (three double-station isolators). The costs considered encompassed personnel, equipment, maintenance, consumables, and electricity. Projections were made over an eight-year period, commencing in 2026, with an anticipated 30% increase in activity over five years. The economic indicators examined included cumulative costs, unit cost per preparation, return on investment, and break-even point. Costs are expressed as inclusive of taxes.

Results
The projection of cumulative costs from 2026 to 2033 indicated savings of €244,659, favoring the robotized scenario. This saving primarily arises from reduced personnel and consumable expenses, while additional costs are associated with the robot’s equipment and maintenance. The return on investment is achieved after 5.8 years, indicating that from this point forward, the savings generated by utilizing the robot offset its initial cost. The break-even point is estimated at 50,000 preparations per year, beyond which automating production is economically advantageous. The average cost per preparation was €19.21 with the robot, compared to €19.73 without the robot. In the robotized scenario, expenses were predominantly distributed among personnel (64%), consumables (21%), maintenance (10%), and equipment (5%), with marginal electricity consumption (0.5%).

Conclusion
Beyond the anticipated enhancements in production capacity and process security, this study, innovative in France, affirms the economic viability of an automation project in the context of increasing activity. Although the study by Masini et al. [1] identifies a break-even point of approximately 34,000 annual preparations, our findings suggest a higher threshold (50,000), reflecting French cost structures and organizational specifics. The return on investment, achieved in nearly six years, is thus highly contingent on production volume, as well as on implemented cost-reduction strategies (consumables optimization and workforce allocation). Continuous monitoring of expenses under real production conditions will validate these projections and allow for parameter adjustments, if necessary.

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