What is the most cost-beneficial way to prepare micafungin for paediatric oncology patients?

Background

A recent change in local paediatric antifungal guidelines resulted in an increase in micafungin use. Micafungin is an expensive medicine costing AUD $80 per vial. The pharmacy aseptic production unit (APU) has the ability to compound doses to share vials of micafungin to minimise wastage.

Aim

To determine whether aseptically compounded and individually prepared doses of micafungin would be more cost-beneficial than nurses using whole vials prepared on the ward, and to determine which dose and numbers of doses would be most cost-beneficial to compound.

Method

A time and motion study of 20 patients determined how long it took for nurses and the pharmacy APU to prepare doses. An economic analysis of time, cost of labour, and consumables outlined the cost to make one to seven doses with doses ranging from 10 to 200 mg.

Results

On average, it took the pharmacy APU 42 min and nurses 9 min to prepare a single dose. Aseptically compounding one dose, whole vials (doses of 50 mg increments), and doses near whole vials had no cost-benefit. Aseptically compounding five doses or more had would result in a cost-benefit.

Conclusion

Depending on the dose required, cost savings could be obtained when the pharmacy APU prepared multiple doses, with a maximum saving of $350.10 for a 7-day course. Determining baseline costs of micafungin preparation is relevant if there are future requests to compound medicines as the data could be extrapolated and applied to the new request.