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Comparative Cost-Effectiveness Analysis of Three Different Automated Medication Systems Implemented in a Danish Hospital Setting

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Abstract

Introduction

Automated medication systems have been found to reduce errors in the medication process, but little is known about the cost-effectiveness of such systems. The objective of this study was to perform a model-based indirect cost-effectiveness comparison of three different, real-world automated medication systems compared with current standard practice.

Methods

The considered automated medication systems were a patient-specific automated medication system (psAMS), a non-patient-specific automated medication system (npsAMS), and a complex automated medication system (cAMS). The economic evaluation used original effect and cost data from prospective, controlled, before-and-after studies of medication systems implemented at a Danish hematological ward and an acute medical unit. Effectiveness was described as the proportion of clinical and procedural error opportunities that were associated with one or more errors. An error was defined as a deviation from the electronic prescription, from standard hospital policy, or from written procedures. The cost assessment was based on 6-month standardization of observed cost data. The model-based comparative cost-effectiveness analyses were conducted with system-specific assumptions of the effect size and costs in scenarios with consumptions of 15,000, 30,000, and 45,000 doses per 6-month period.

Results

With 30,000 doses the cost-effectiveness model showed that the cost-effectiveness ratio expressed as the cost per avoided clinical error was €24 for the psAMS, €26 for the npsAMS, and €386 for the cAMS. Comparison of the cost-effectiveness of the three systems in relation to different valuations of an avoided error showed that the psAMS was the most cost-effective system regardless of error type or valuation.

Conclusion

The model-based indirect comparison against the conventional practice showed that psAMS and npsAMS were more cost-effective than the cAMS alternative, and that psAMS was more cost-effective than npsAMS.

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Acknowledgements

This study could not have been performed without the intensive work of the project group, which included both clinical and hospital pharmaceutical staff, who were active in the planning and implementation of the intervention. We thank the pharmaceutical staff who participated in the data collection and the supervisory group within the Hospital Pharmacy who followed and supported the study. Thanks also to the Steering Committee for their support for the study and assistance in communicating the results to a wider audience. We thank Sharon Preece for comments and language editing of the manuscript.

Author information

Authors and Affiliations

  1. Department of Public Health, Centre for Health Economic Research (COHERE), University of Southern Denmark, J.B. Winsløwsvej 9B, 5000, Odense C, Denmark

    Bettina Wulff Risør & Jan Sørensen

  2. Hospital Pharmacy, Central Denmark Region, Nørrebrogade 44, 8000, Aarhus C, Denmark

    Bettina Wulff Risør

  3. Research Center of Emergency Medicine, Aarhus University Hospital, Building 1B, Nørrebrogade 44, 8000, Aarhus C, Denmark

    Marianne Lisby

  4. Healthcare Outcome Research Centre, Royal College of Surgeons in Ireland, Beaux Lane House, Dublin 2, Ireland

    Jan Sørensen

Authors
  1. Bettina Wulff Risør
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  3. Jan Sørensen
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Corresponding author

Correspondence to Bettina Wulff Risør.

Ethics declarations

The data collection for this study was registered and approved by the Danish Data Protection Agency (journal no. 1-16-02-163-12). According to Danish law, this study did not require ethical approval from the National Committee on Health Research Ethics. This is a part of BWR’s PhD program. The study was financially supported by the Research and Development Fund”, which is administered by the pharmaceutical procurement service for the five regional authorities in Denmark (AMGROS). The project ID is U-0034.

Author Contribution

BWR developed the study, designed the data collection, and planned all observations and data collections in cooperation with the pharmaceutical staff. She performed the analyses and drafted the manuscript. ML made substantial contributions to the conception, study design and data collections. She critically commented on the manuscript. JS has made substantial contributions to developing and designing the study and data collections. He contributed to the analyses and drafting of the manuscript. All authors approved the final manuscript.

Data Availability Statement

The raw data represent confidential information and cannot be made public available according to the specific data license agreement (granted solely for the purpose of the project evaluation). The Stata software code is available upon request.

Conflict of interest

Bettina W. Risør, Marianne Lisby, and Jan Sørensen declare that they have no conflicts of interest.

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Risør, B.W., Lisby, M. & Sørensen, J. Comparative Cost-Effectiveness Analysis of Three Different Automated Medication Systems Implemented in a Danish Hospital Setting. Appl Health Econ Health Policy 16, 91–106 (2018). https://doi.org/10.1007/s40258-017-0360-8

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