Background Opioids easily cause adverse drug events (ADEs) or therapeutic failure in cases of prescribing errors, resulting in increased costs for the hospital, patient and healthcare system. The clinical pharmacist can detect and resolve these errors by performing prescription order validation (POV). Little data is available on the economic impact of this service.
Purpose To evaluate the cost-outcome of pharmacist-initiated interventions on opioid prescriptions during POV, in terms of cost savings and cost avoidance (CA) for the institution.
Material and methods Pharmacist interventions in prescriptions of fentanyl, hydromorphone, methadone, morphine, oxycodone and piritramide in a Belgian tertiary university hospital of 721 beds, UZ Brussel, were analysed (period 1 February 2017–31 January 2018). The potential drug cost without intervention was compared to the cost with intervention. An expert panel assessed the probability of ADE occurrence by assigning a probability estimate (PE) to every patient (0–no effect; 0.01–very low; 0.1–low; 0.4–medium; 0.6–high). The ADE-CA was calculated by multiplying the hospital’s cost of an ADE (calculated according to a method proposed by the Belgian Healthcare Knowledge Centre) by the PE. The total benefit was calculated as the sum of the drug cost difference and the ADE-CA. Personnel costs were estimated and subtracted from the estimated benefit to assess the final cost-benefit. A sensitivity analysis was added to determine the impact of assumptions on PEs, CA and employer’s expenses.
Results In 3040 prescriptions, 94 interventions were registered. Posology-related DRPs were the most common (59%). Sixty-two per cent of the errors were assigned a PE of medium (30%) or high (32%) level. Total drug cost savings amounted to €395.30 (median €1.47/intervention, range -€21.01 to €67.23). After adding ADE-CA, we found a total benefit of €8,559.92 (cost-benefit ratio: 2.32). Mostly variations in the ADE-CA affected the outcome. A lower and upper limit of respectively -€1,386.56 and €27,307.49 were calculated.
Conclusion This is the first Belgian study to evaluate the POV of opioids as a profitable service for the hospital. Because of some limitations in the method, further refinements are required for more accurate results. These findings demonstrate that hospital management should also take into account the potential savings induced by clinical pharmacists and cannot only rely on limited government funding.
References and/or acknowledgements None.
No conflict of interest.
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