Resource Utilization and Total Cost of Commercially-Available versus Manually-Compounded Solutions Used for Dialysate in Continuous Renal Replacement Therapy

Abstract

Purpose The acquisition cost of commercially-available (CA) dialysis solutions is higher than manually-compounded (MC) solutions but pharmacy preparation time and medication errors are presumed to be lower. The objective of this study was to compare resource utilization and total cost between CA- and MC-dialysis solutions. Methods A model was constructed using solution acquisition cost, preparation cost, and the cost of a medication error. Solution preparation costs were obtained by prospectively recording preparation times for 1 month before and after the implementation of a CA-solution protocol. Preparation times were converted to costs using the hourly wage of a pharmacist and pharmacy technician. The presumed error rate was 0.5% for MC and 0.1% for CA solutions. A univariate sensitivity analysis was conducted by varying the incidence of a medication error. Results Preparation time for an MC solution was significantly longer than for a CA solution (8 ± 3 minutes/bag vs 4 ± 1 minutes/bag, P < .001). Total solution costs (acquisition + preparation) were $11.13 and $26.38 per bag for MC and CA, respectively. When medication errors were considered, the cost per error-free event was $48.14 per bag for MC solutions and $33.77 per bag for CA solutions. The threshold where the cost-ratio became less costly for MC solutions was when the absolute difference in error rate was no more than 0.2%. Conclusion Despite a higher acquisition cost, CA solutions could result in lower total costs compared with MC solutions. A small difference in medication error rate is required to produce these savings.