title: A multi-centre comparison of nursing staff time required for the preparation and administration of liposomal amphotericin B and amphotericin B deoxycholate vs. voriconazole.
abstract: OBJECTIVE
  To compare the nursing time and cost required for preparation and administration of liposomal amphotericin B, amphotericin B deoxycholate and voriconazole.
  
  
  METHODS
  Cost comparison study.
  
  
  METHODS
  Nurse activities associated with the preparation and administration of the three study drugs were divided into 11 tasks and timed by observers at five hospitals. Target tasks were defined as those likely to be affected by the differences between drugs and excluded those tasks likely to differ owing to site-specific factors. Mean times for administration of a single day of therapy for each study drug were compared. Costs of preparation and administration of a 14-day regimen were estimated.
  
  
  RESULTS
  Sixty-nine patients were observed receiving a total of 256 doses of study medications. Labour times were 20, 16, 14 and 3 minutes per day for liposomal amphotericin B, amphotericin B deoxycholate, intravenous voriconazole and oral voriconazole, respectively. Administration time was significantly lower for intravenous voriconazole compared with liposomal amphotericin B (p < 0.05), and for oral voriconazole compared with all intravenous regimens (p < 0.05). Preparation of medications took the longest time for intravenous formulations and was longer for liposomal amphotericin B than for the other drugs by 3-5 minutes. Average non-drug costs associated with preparation and administration of a 14-day regimen were greatest in the amphotericin B deoxycholate arm at US$ 335, followed by liposomal amphotericin B (US$ 310) and voriconazole (US$ 180).
  
  
  CONCLUSIONS
  Intravenous voriconazole required less time to prepare and administer on a daily basis than liposomal amphotericin B, and was similar to amphotericin B deoxycholate. Measurements of intravenous vs. oral voriconazole administration suggest the opportunity to save 10-17 minutes per day with the oral formulation.
  
  
  CONCLUSIONS
  Oral voriconazole may provide significant savings in terms of nursing time compared with intravenous antifungal drugs.
authors.affiliation: Center for Pharmacy Operations and Designs, Auburn, AL 36849-5506, USA. flynnel@auburn.edu
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Flynn
authors.forename: Anne
authors.initials: A
authors.lastname: Marciniak
authors.forename: Giuliana
authors.initials: G
authors.lastname: Barbabietola
authors.forename: Beryl A
authors.initials: BA
authors.lastname: Oppenheim
authors.forename: Craig
authors.initials: C
authors.lastname: Roberts
authors.forename: Kenneth
authors.initials: K
authors.lastname: Barker
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000032:analysis*; D003365:Costs and Cost Analysis; D003840:Deoxycholic Acid / Q000008:administration & dosage*; D004338:Drug Combinations; D006801:Humans; D011743:Pyrimidines / Q000032:analysis*; D017748:Time Management; D014230:Triazoles / Q000032:analysis*; D006113:United Kingdom; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D065819:Voriconazole