title: Budget impact assessment of Aprokam® compared with unlicensed cefuroxime for prophylaxis of post-cataract surgery endophthalmitis.
abstract: BACKGROUND
  Intracameral cefuroxime is recommended as prophylaxis against postoperative endophthalmitis (POE) following cataract surgery. Aprokam is the only licensed product for prophylaxis of POE, although unlicensed intracameral cefuroxime may be administered using pre-filled syringes (PFS), either prepared in hospital by reconstituting cefuroxime via serial dilution (prepared PFS), or commercially purchased (purchased PFS). This study aimed to estimate the potential budget impact of using Aprokam over unlicensed cefuroxime for intracameral administration.
  
  
  METHODS
  A budget impact model (BIM) was developed from UK NHS hospital perspective to estimate the economic impact of adopting Aprokam compared with purchased PFS or prepared PFS for the prophylaxis of POE following cataract surgery over a 5-year time horizon. The BIM incorporated direct costs only, associated with the acquisition, delivery, storage, preparation, and administration of cefuroxime. Resource utilisation costs were also incorporated; resource utilisation was sourced from a panel survey of hospital pharmacists, surgeons, and theatre nurses who are involved in the delivery, storage, preparation, quality assurance, or administration of cefuroxime formulations. Unit costs were sourced from NHS sources; drug acquisition costs were sourced from BNF. The model base case used a hypothetical cohort comprising of 1000 surgeries in the first year and followed a 5.2 % annual increase each year.
  
  
  RESULTS
  The model predicts Aprokam is cost saving compared with purchased PFS, with a modest increase compared prepared PFS over 5 years. There are total savings of £ 3490 with Aprokam compared with purchased PFS, driven by savings in staff costs that offset greater drug acquisition costs. Compared with prepared PFS, there are greater drug acquisition costs which drive an increased total cost over 5 years of £ 13,177 with Aprokam, although there are substantial savings in staff costs as well as consumables and equipment costs.
  
  
  CONCLUSIONS
  The lower direct costs of using Aprokam compared with purchased PFS presents a strong argument for the adoption of Aprokam where purchased PFS is administered. The additional benefits of Aprokam include increased liability coverage and possible reduction in dilution errors and contaminations; as such, in hospitals where unlicensed prepared PFS is used, modest additional resources should be allocated to adoption of Aprokam.
authors.affiliation: Théa Pharmaceuticals Ltd, MED IC3, Keele University Science and Business Park, Keele University, Newcastle under Lyme, North Staffordshire, ST5 5NP, UK. christine.purslow@theapharma.co.uk.
authors.forename: Christine
authors.initials: C
authors.lastname: Purslow
authors.affiliation: Spire Elland Hospital, Elland Lane, Elland, West Yorkshire, HX5 9 EB, UK. keithgdavey@gmail.com.
authors.forename: Keith
authors.initials: K
authors.lastname: Davey
authors.affiliation: Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK. Mildred.Johnson@moorfields.nhs.uk.
authors.forename: Mildred
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Health Economic Modelling Unit, HERON™ Commercialization, PAREXEL International, Evergreen Building North, 160 Euston Road, London, NW1 2DX, UK. Guilhem.Pietri@parexel.com.
authors.forename: Guilhem
authors.initials: G
authors.lastname: Pietri
authors.affiliation: Health Economic Modelling Unit, HERON™ Commercialization, PAREXEL International, Evergreen Building North, 160 Euston Road, London, NW1 2DX, UK. Gaurav.Suri@parexel.com.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Suri
mesh_terms: D000867:Anterior Chamber / Q000187:drug effects; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000191:economics*; D002017:Budgets; D002387:Cataract Extraction; D002444:Cefuroxime / Q000191:economics* / Q000627:therapeutic use; D017046:Cost Savings; D004339:Drug Compounding / Q000191:economics; D016527:Drug Costs; D009877:Endophthalmitis / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D015818:Eye Infections, Bacterial / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D056965:Injections, Intraocular; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics; D056687:Off-Label Use; D011183:Postoperative Complications; D013810:Therapeutic Equivalency; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents; D002444:Cefuroxime