Background and Importance Most intravenous admixtures (IVA) are prepared on the wards just before their administration to the patient, discarding the spare volume left in vials afterwards. This wasted volume is especially significant in injectables used in paediatrics. To avoid this, hospital pharmacy Central Intravenous Additive Services (CIVAS) centralise the preparation of IVAs, reducing waste and saving costs.

Aim and Objectives To evaluate the economic impact of centralising injectable paediatric antifungal drugs in a tertiary hospital CIVAS from January to December 2021.

Material and Methods The cost incurred by the preparation of paediatric antifungals on the wards versus CIVAS was estimated. To do this, data were collected from the electronic prescribing system and the centralised preparation costs were calculated considering the number of vials, diluting agents, extra personnel time (0.90€/preparation) and clothing (0,11€ and 0,16€ in a non-hazardous cabin and hazardous cabin, respectively). Expenses on the ward were calculated based on what it would have cost were they not centralised. These calculations were based on the maximum ex-factory price plus VAT minus a national discount.

Results Three drugs were selected for centralisation, namely liposomal amphotericin B (LAB), micafungin and vorizonazol. Stock solutions were prepared for these drugs at a concentration of 1 mg/mL for LAB and micafungin, and 5 mg/mL for voriconazole, which were then used to prepare different patient specific IVAs. During the time period, a total of 2,423 paediatric antifungals were centralised, which comprised 863 LAB, 1531 micafungin, and only 29 voriconazol IVAs. Saving costs between the ward and the CIVAS were just above 26000€ for LAB, about 72000€ for micafungin, and 250€ for voriconazole, which accounted for a total of 96500€ approximately, considering personnel and clothing costs.

Conclusion and Relevance Centralising antifungal drugs into CIVAS in hospital pharmacies is an efficient measure to reduce waste and costs. This is especially important for highly prescribed paediatric IVAs such as LAB and micafungin, and less so for voriconazole which is far less commonly prescribed in paediatrics, being mainly prepared in CIVAS for safety reasons¹.

References and/or Acknowledgements 1. NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, 2020 [Internet] U.S. Department of Health and Human Services. Last Updated September 2020. Available from http://www.cdc.gov

Conflict of Interest No conflict of interest.