Background and importance Patient involvement is increasingly becoming part of clinical practice, including self-administration of medication (SAM) during hospitalisation. Previously, we have investigated the effectiveness of SAM in a randomised controlled trial (RCT). The proportion of ward level dispensing errors was considered the best way to explore safety difference between workflows. We saw that SAM was effective, and also user friendly. However, due to the scarcity of healthcare resources, a health economic evaluation is important when choosing the best, safest and most economically advantageous way to manage medication in hospital.
Aim and objectives To evaluate the cost effectiveness of SAM during hospitalisation compared with nurse-led medication dispensing and administration.
Material and methods A cost analysis (microcosting level) was performed from a hospital perspective with a short term incremental costing approach, including the costs of medication, materials and nursing time spent on dispensing, administration, SAM start and discharge preparation.
The RCT was performed in a cardiology unit and included patients ≥18 years that were capable of SAM. In the intervention group, patients were instructed about the medication and self-administered their own medication. In the control group, medication was dispensed by nurses in the ward.
The proportion of ward level dispensing errors was collected through disguised observation of patients in the patient room and nurses in the medicine room.
A dispensing error was defined as a deviation between the prescription and the dispensed medication (eg, incorrect dose). Opportunity for errors (OEs) was defined as any medication dispensed and any medication prescribed but not dispensed. Dispensing error proportion=(dispensing errors/OEs)×100%.
Results A total of 250 patients were recruited; 11 were withdrawn as they were discharged prior to observation. The proportion of men was 66% and mean age was 64.2 years (SD 12.2). Total cost per patient in the intervention group was 49.9€ (95% CI 46.7; 53.1€) compared with 52.6€ (95% CI 47.1; 58.1€) in the control group (p=0.09). Sensitivity analysis consistently showed total costs favouring the intervention. The dispensing error proportion was 9.7% (95% CI 7.9 to 11.6%) (100 errors/1033 OEs) in the intervention group compared with 12.8% (95% CI 10.9 to 15.6) (132 errors/1028 OEs) in the control group (p=0.02).
Conclusion and relevance SAM seem to cost less but the results were not statistically significant. As SAM patients made fewer dispensing errors compared with nurse-led medication dispensing, the results are suggested to be cost effective.
References and/or acknowledgements No conflict of interest.
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