title: Clinical and economic impact of pharmacists' intervention in a large volume chemotherapy preparation unit.
abstract: Background Even though pharmacists have devoted considerable time to ensuring patient safety during the process of preparing and dispensing chemotherapy, only a few studies have evaluated their efforts. Objective To evaluate the clinical and economic impact of pharmacists' interventions in a large volume chemotherapy preparation unit. Setting A 1600-bed tertiary hospital in Seoul, Korea. Method Pharmacist intervention records from May 2012 to April 2013 were retrospectively reviewed. The clinical significance of interventions was rated by one physician and one pharmacist. A cost-benefit analysis was conducted. The benefit from interventions was estimated through both cost avoidance based on the potential to avoid an adverse drug event (ADE) and cost savings related to reducing discarded products. Cost was estimated from the pharmacists' salary corresponding to the time spent in reviewing chemotherapy prescriptions. Main outcome measure Acceptance rate, clinical significance, net cost-benefit, and cost-benefit ratio of pharmacist interventions. Results Among 39,649 cancer chemotherapy prescriptions in 6364 patients, 631 interventions were performed for 435 patients. The acceptance rate was 72.1 %. Most cases of declined interventions were related to dosage adjustment within the range of <10 % of the prescribed dosage. More than half of the interventions were considered as clinically more than "significant" (50.4 %). The cost-benefit analysis showed a clear cost benefit with a net cost-benefit of $116,493 and a cost-benefit ratio of 3.64:1. Conclusion Pharmacists' interventions in a large volume ambulatory-based chemotherapy preparation unit provided a positive economic impact on health care budget and were effective in preventing clinically significant ADEs.
authors.affiliation: Department of Pharmacy, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Ji-Min
authors.initials: JM
authors.lastname: Han
authors.affiliation: College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Gyeonggi-do, South Korea.
authors.forename: Young-Mi
authors.initials: YM
authors.lastname: Ah
authors.affiliation: Department of Pharmacy, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Sung Yun
authors.initials: SY
authors.lastname: Suh
authors.affiliation: Department of Pharmacy, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Sun-Hoi
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Department of Pharmacy, Seoul National University Hospital, Seoul, South Korea.
authors.forename: Hyeon Joo
authors.initials: HJ
authors.lastname: Hahn
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Seock-Ah
authors.initials: SA
authors.lastname: Im
authors.affiliation: College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, Gyeonggi-do, South Korea. jypharm@hanyang.ac.kr.
authors.forename: Ju-Yeun
authors.initials: JY
authors.lastname: Lee
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010595:Pharmacists / Q000191:economics*; D010607:Pharmacy Service, Hospital / Q000191:economics* / Q000379:methods*; D024382:Professional Role; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Compounding; Cost-benefit; Korea; Pharmacist intervention