Costs and Cost-Effectiveness of User-Testing of Health Professionals' Guidelines to Reduce the Frequency of Intravenous Medicines Administration Errors by Nurses in the United Kingdom: A Probabilistic Model Based on Voriconazole Administration

Matthew D. Jones*, Bryony Dean Franklin, D K Raynor, Howard Thom, Margaret C. Watson, Rebecca Kandiyali

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Abstract

AIM: In the UK, injectable medicines are often prepared and administered by nurses following the Injectable Medicines Guide (IMG). Our earlier study confirmed a higher frequency of correct administration with user-tested versus standard IMG guidelines. This current study aimed to model the cost-effectiveness of user-testing.

METHODS: The costs and cost-effectiveness of user-testing were explored by modifying an existing probabilistic decision-analytic model. The adapted model considered administration of intravenous voriconazole to hospital inpatients by nurses. It included 11 error types, their probability of detection and level of harm. Model inputs (including costs) were derived from our previous study and other published data. Monte Carlo simulation using 20,000 samples (sufficient for convergence) was performed with a 5-year time horizon from the perspective of the 121 NHS trusts and health boards that use the IMG. Sensitivity analyses were undertaken for the risk of a medication error and other sources of uncertainty.

RESULTS: The net monetary benefit at £20,000/quality-adjusted life year was £3,190,064 (95% credible interval (CrI): -346,709 to 8,480,665), favouring user-testing with a 96% chance of cost-effectiveness. Incremental cost-savings were £240,943 (95% CrI 43,527-491,576), also favouring user-tested guidelines with a 99% chance of cost-saving. The total user testing cost was £6317 (95% CrI 6012-6627). These findings were robust to assumptions about a range of input parameters, but greater uncertainty was seen with a lower medication error risk.

CONCLUSIONS: User-testing of injectable medicines guidelines is a low-cost intervention that is highly likely to be cost-effective, especially for high-risk medicines.

Original languageEnglish
Pages (from-to)91-104
Number of pages14
JournalApplied Health Economics and Health Policy
Volume20
Issue number1
Early online date17 Aug 2021
DOIs
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
Matthew Jones is funded by a National Institute for Health Research (NIHR) Transitional Research Fellowship for this research project. Howard Thom was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. Margaret Watson was funded by a Health Foundation Improvement Science Fellowship. This paper presents independent research funded by the National Institute for Health Research (NIHR), the NIHR Imperial Patient Safety Translational Research Centre and the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College in partnership with Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, PHE or the Department of Health and Social Care. We are grateful to John Karnon (University of Adelaide) for providing copies of his original model and Robin Burfield (NHS Wales Informatics Service) for providing information on the usage of the Injectable Medicines Guide. We also thank all the NHS organisations who provided information in response to our Freedom of Information request.

Funding Information:
Matthew Jones is funded by a National Institute for Health Research (NIHR) Transitional Research Fellowship for this research project. Howard Thom was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. Margaret Watson was funded by a Health Foundation Improvement Science Fellowship. This paper presents independent research funded by the National Institute for Health Research (NIHR), the NIHR Imperial Patient Safety Translational Research Centre and the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College in partnership with Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, PHE or the Department of Health and Social Care. We are grateful to John Karnon (University of Adelaide) for providing copies of his original model and Robin Burfield (NHS Wales Informatics Service) for providing information on the usage of the Injectable Medicines Guide. We also thank all the NHS organisations who provided information in response to our Freedom of Information request.

Funding Information:
Matthew Jones is funded by a National Institute for Health Research (NIHR), Transitional Research Fellowship for this research project (grant number TRF-2017-10-006). Howard Thom was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. Margaret Watson was funded by a Health Foundation Improvement Science Fellowship. Bryony Dean Franklin is supported by the NIHR Imperial Patient Safety Translational Research Centre and the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College in partnership with Public Health England (PHE).

Publisher Copyright:
© 2021, The Author(s).

Structured keywords

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