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Cost-effectiveness of two technology-assisted manual medication picking systems versus traditional manual picking in a hospital outpatient pharmacy
  1. Marcus Eng Hwa Teo1,
  2. Bih Yee Chia1,
  3. Yeng Ching Lee1,
  4. Pearlyn Li Ying Tay1,
  5. Jane Ai Wong1,
  6. Soo Boon Lee1,
  7. Mun Moon Lim1,
  8. McVin Hua Heng Cheen1,2
  1. 1 Pharmacy, Singapore General Hospital Department of Pharmacy, Singapore
  2. 2 Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
  1. Correspondence to Dr McVin Hua Heng Cheen, Pharmacy, Singapore General Hospital Department of Pharmacy, Singapore 169608, Singapore; mcvin_chen{at}


Objective To evaluate the cost-effectiveness of two technology assisted manual medication picking systems vs traditional manual picking.

Methods This was a retrospective observational study comparing three outpatient pharmacies of a tertiary referral hospital in Singapore, where a light-emitting diode (LED-guided) manual picking system, an LED-guided manual picking plus lockable drawer (LED-LD) system, and traditional manual picking were implemented, respectively. The primary outcome measure was the incidence of medication near-misses over the observation period. The incremental cost-effectiveness ratio (ICER) per near-miss avoided was also determined. Data on medications picked and near-misses reported between September 2017 and June 2018 were retrieved from electronic databases. The incidence of medication near-misses from the LED-guided and LED-LD systems, relative to traditional picking, was compared using logistic regression. We compared annual operating costs between manual medication picking systems, and reported ICERs per near-miss avoided, to evaluate the cost-effectiveness of each picking system.

Results A total of 358 144, 397 343 and 254 162 medications were picked by traditional manual picking, LED-guided and LED-LD systems, respectively. The corresponding near-miss rates were 8.32, 4.08 and 0.69 per 10 000 medications picked, respectively. Medication near-miss rates were significantly lower for the LED-guided (OR 0.49, 95% CI 0.40 to 0.59, p<0.001) and LED-LD systems (OR 0.08, 95% CI 0.05 to 0.13, p<0.001) compared with traditional picking. The annual operating costs of traditional picking, LED-guided and LED-LD systems were S$60 912, S$129 832 and S$152 894, respectively. The LED-guided and LED-LD systems yielded ICERs of S$189 and S$140 per near-miss avoided, respectively, compared with traditional manual picking.

Conclusion The LED-LD system is more cost-effective than both the LED-guided and manual medication picking systems in reducing medication picking near-misses.

  • pharmacy
  • technology
  • automation
  • medication safety
  • cost-effectiveness
  • Singapore

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