How investing in automation can lead to short-term horizon return on investment (ROI)

The increasing demands on oncology services continue to stretch healthcare budgets, with the number of new cancer patients in Europe each year at 3.7 million¹ and the total annual cost of cancer in the region at €199 billion².

Cancer care currently consumes around 5% of all healthcare costs globally, with the growth in spending on cancer outstripping the growth in total health expenditure.^3,4 This is not sustainable: budgets cannot keep rising indefinitely to meet these increasing needs.

One solution to help reduce oncology costs is through the implementation of automated* workflows. They can transform the oncology treatment pathway within hospitals, allowing organizations to increase efficiency, maximise resources, and ultimately reduce costs.

The initial investment required to implement new technologies can be a daunting prospect, especially as healthcare organisations are often already financially stretched. Therefore, having evidence demonstrating short-term horizon return on investment from the adoption of automated* workflows is important for key decision makers.

Reducing medication errors

The focus on medication safety with regards to drug errors is critical, as organisations want to ensure cancer patients are safe and receive the highest quality treatment.

However, another reason they are important is due to the cost implications of medication errors. This can be a result of staff time and the consumption of resources required to investigate and rectify the error, the patient requiring additional treatment and an increased length of hospital stay, litigation claims, potential damage to an organisation’s reputation, and so on. A 2011 study on chemotherapy in hospitalised patients showed that 449 errors generated an additional cost of €100,000 and if they had remained undetected, would have generated 216 additional days of hospitalisation.⁵ Error reduction, therefore, means reduced oncology costs.

The compounding of chemotherapy drugs by the pharmacy is a process where there is high risk of error. With manual compounding methods, many of these errors go undetected and potentially reach the patient. Automated* workflows within the compounding process via the integration of IV workflow software, barcode scanners, gravimetric scales and cameras, helps ensure the correct preparation of a drug. This was demonstrated by a large-scale European multi-center study that assessed the impact of automation. The study involved 759,060 chemotherapy preparations and showed the mean out-of-tolerance error rate during compounding to be 10.44%.⁶ These errors outside the accepted tolerance level were detected by the gravimetric technology and able to be corrected. The study concluded that it was unlikely these errors would have been detected using a manual compounding process.

Chemotherapy prescribing is also a high-risk area for error. Two independent studies showed that Computerized Physician Order Entry (CPOE) systems cut oncology medication error rates in hospitals by approximately two-thirds^7,8 when compared to handwritten prescriptions.

Reduce medication waste

Drug expenditure in oncology is significant. Within Europe, €32 billion is spent annually on cancer drugs, and this figure continues to rise.⁹ Therefore, looking for ways for your organisation to reduce drug expenditure and oncology costs is key.

Reducing medication waste within oncology is one way to achieve this. One study reported drug wastage accounted for 8.3% of the oncology department’s annual drug expenditure.¹⁰

The implementation of automated* workflows can help address these causes of medication wastage and potentially reduce oncology costs overall.

An automated* IV workflow software system can be used to electronically record the return of part-used vials to the pharmacy’s inventory. It produces a vial label detailing the remaining contents of the vial, with a suitable use-by date as per the manufacturer’s recommendations post reconstitution. The system also suggests the most appropriate vial to select during the assembly process prior to compounding, helping to ensure effective stock rotation and any part-used vials are used up where possible to minimise waste.

Any changes made to a prescription are updated in real time to all users. Therefore, if a treatment is cancelled, this will be visible to the pharmacy department immediately, reducing the likelihood that the dose continues to be prepared in error.

Additionally, automated* workflow systems identify errors at the point they occur in the process, allowing them to be corrected immediately. This reduces the likelihood of having to remake the entire dose, which incurs costs through drug wastage and time. This benefit is demonstrated in the Reece et al study¹¹, which assessed the impact of a gravimetric i.v. workflow software system (BD Cato™) in an oncology ambulatory care pharmacy. All the 49 errors detected using a manual workflow system (prior to the implementation of BD Cato™) resulted in the entire preparation having to be discarded, amounting to over $56,000 in waste. Post implementation of BD Cato™, 12 errors detected required discarding of the drug, resulting in $12,398 in waste. However, the remaining 1,114 errors detected with the software were corrected before the final dose was completed and did not incur waste.

The closed system transfer device BD PhaSeal™ helps prevent microbial contamination of the vial during compounding, which may lead to a reduction in drug waste and cost savings. One study revealed that using the BD PhaSeal™ system, the pharmacy avoided nearly half of potential waste and saved a mean of 29% per vial. This equates to an annual cost saving of $703,047.67, which more than offsets the original cost of the BD PhaSeal™ system¹².