POSC65 Cost-Benefit Analysis of Ready-to-Administer Noradrenaline for Hypotensive Emergency on Intensive Care

ABSTRACT

Objectives: COVID-19 has demanded innovation in critical care and shone a light on ready-to-administer formulations for intravenous administration. This analysis quantifies the human resource released when moving away from traditional mixing of drug concentrate at the bedside. Methods: A model was constructed to simulate noradrenaline delivery for people experiencing critical hypotension requiring vasopressor support in the intensive care setting. It simulated resource consumption over 24 hours taking account of noradrenaline dose and flow rate, product size, ampoule pooling for dilution, preparation volume, sterility changes, pumping methods, and drug wastage. The duration, location and skill requirement of human-resourced tasks were also included and costed. Outcomes were applied to a hypothetical English population over one year (2019). Results: Based on 4,123 critical care beds giving 231,011 days of vasopressor support annually, and a move from syringe-based double pumping to volumetric pumping in 80% of units (20% estimated to deliver volumetrically already), a comprehensive switch to the ready-to-administer formulation released 33,927 days (167.1 WTEs) of nursing time from non-patient facing activity. A resource equivalent to £11.0m at 50/50 band 5/6. There were fewer episodes of preparation needed, no ampoule cracking or pooling for dilution, and no injection into infusion bags and changing with ensuing sterility risk. The cost of moving to the ready-to-administer product was £2.2m in acquisition (Sinora®). When monetised throughout, there was a net saving of £8.7m. Conclusions: The human resource of the NHS is its highest value component as made evident by the COVID-19 pandemic. This modelling supports the recommendations of the Lord Carter review, the Royal Pharmaceutical Society, and the NHS Specialist Pharmacy Service in their encouragement of ready-to-administer formulations in this context of care. Resource-effective approaches will help skilled healthcare professionals divert their time from therapy preparation to patient-facing care.