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Table 3 Summary of resource utilization and unit cost/annual cost for each cefuroxime formulation (2013 GB £)

From: Budget impact assessment of Aprokam® compared with unlicensed cefuroxime for prophylaxis of post-cataract surgery endophthalmitis

 

Resource utilization (number of units or staff time in minutes)

Unit cost/annual cost (2013 GB £)

Comments

Aprokam

Purchased PFS

Prepared PFS

Delivery

Pharmacy store manager (delivery)

2.5

1.5

2.5

45.8 [29, 30]

Time related to the paperwork upon delivery

Nurse team manager

9.9

43.0

18.0

50.0 [30]

Time related to weekly (prepared and purchased PFS) or monthly (Aprokam) ordering of individual doses by the theatre nurse to check the theatre stock (3 min), order additional stock to the hospital pharmacy and store it (15 min) and order additional stock from the manufacturer directly (purchased PFS and Aprokam only, 25 min)

Pharmacy store manager (QA during delivery)

N/A

1.3

N/A

45.8 [29, 30]

Time spent to check labelling of purchased PFS

Pharmacy store manager (transfer to storage area)

1.7

1.7

1.7

45.8 [29, 30]

Time related to the transport from delivery area to storage pharmacy storage

Storage

Pharmacy fridge

N/A

1

N/A

132.0 [31]

Upon delivery, only refrigerated PFS requires storage in a fridge

Operating room fridge

N/A

1

N/A

37.7 [32]

 

Porter (transport between storage areas)

9.6

9.6

9.6

20.0 [29, 30, 33]

Time spent to transport cefuroxime from pharmacy to theatre

Pharmacy technician (QA)

N/A

0.5

N/A

45.8 [29, 30]

Daily time spent for temperature control

Theatre nurse (QA)

N/A

0.5

N/A

43.6 [29, 30]

Daily time spent for temperature control

Preparation

Consumables

     

1 ml syringe

1

N/A

27

0.11 [34]

The list of consumables required for the reconstitution of Aprokam is based on the reconstitution protocol described in Aprokam SPC related to one single dose

10 ml syringe

N/A

N/A

1

0.17 [34]

The list of consumables used for the preparation of PFS at the hospital pharmacy is based on feedback from the panel survey. The list of consumables also includes those related to quality assurance procedures

15 ml syringe

1

N/A

N/A

0.20 [34]

     

The model assumes that 15 mL of saline solution are required for the preparation of one individual PFS

50 ml syringe

N/A

N/A

2

0.56 [34]

Drawing up needle

2

N/A

2

0.02 [35]

0.2 μm filter

N/A

N/A

1

2.31 [34]

Connector

N/A

N/A

3

1.09 [36]

Sterile syringe cap

N/A

N/A

27

1.24 [37]

1 ml 0.9 % NaCl solution

5

N/A

408

0.01 [38]

Heat-seal sterile pouch

N/A

N/A

52

0.07 [39]

Equipment

Laminar hood

N/A

N/A

1

655.1 [40]

Injectable syringes of cefuroxime are required to be prepared in a controlled atmosphere

Pharmacy fridge

N/A

N/A

1

132.0 [31]

During transfer to storage, storage, storage control and any QA test performed during storage, only prepared PFS requires. storage in a pharmacy fridge

Operating room fridge

1

1

1

37.7 [32]

During transfer to storage, storage, storage control and any QA test performed during storage, all cefuroxime formulations requires storage in an operating room fridge

Staff

Pharmacy technician (preparation)

N/A

N/A

36.0

45.8 [29, 30]

Time spent to perform the preparation of PFS in the pharmacy

Theatre nurse (transfer to storage)

N/A

1.0

N/A

43.6 [29, 30]

Time spent to transfer purchased PFS to storage area

Pharmacy technician (storage)

N/A

N/A

13.1

45.8 [29, 30]

Time spent post-preparation to transfer to storage, conduct, storage control and any other QA test performed during storage

Theatre nurse (preparation)

2.3

1.5

N/A

43.6 [29, 30]

Time spent in the theatre for the reconstitution of Aprokam or the preparation of purchased PFS

QA of prepared PFS

HPLC diode array detector (QA - Ingredient identity test)

N/A

N/A

1

46.9 [41]

The list of these resources was based on the quality assurance protocols for compounding sterile preparations published by the Royal Pharmaceutical Society in the UK [22], the World Health Organization [23], and the American Society of Health-System Pharmacists [12], to prevent dilution errors and contamination

Monochromator (QA - Ingredient identity test)

N/A

N/A

1

34.6 [42]

UV-vis spectrophotometer (QA - Ingredient identity test)

N/A

N/A

1

168.0 [43]

Head pharmacist (QA - Ingredient identity test)

N/A

N/A

2.5

49.4 [29, 30]

HPLC diode array detector (QA - Strength test)

N/A

N/A

1

46.9* [41]

Head pharmacist (QA - Strength test)

N/A

N/A

2.5

49.4 [29, 30]

Sample tube (QA- Purity test)

N/A

N/A

1

0.26 [44]

pH meter (QA- Purity test)

N/A

N/A

1

12.3 [45]

Osmometer (QA- Purity test)

N/A

N/A

1

73.7 [46]

Head pharmacist (QA - Purity test)

N/A

N/A

2.5

49.4 [29, 30]

Incubator (QA - Sterility test)

N/A

N/A

1

153.1 [47]

Head pharmacist (QA - Sterility test)

N/A

N/A

2.5

49.4 [29, 30]

Head pharmacist (QA - Environmental test)

N/A

N/A

2.5

49.4 [29, 30]

Head pharmacist (QA - Label and bagging)

N/A

N/A

2.1

49.4 [29, 30]

Administration

Surgeon

1.0

1.0

1.0

100.0 [29, 30]

Time spent to intracamerally administer cefuroxime

Theatre nurse (QA)

N/A

N/A

1.0

43.6 [29, 30]

Time spent to check prior to intracameral administration

  1. Table legend: Cost inputs by phase (delivery, storage, preparation, and administration) of the cefuroxime preparation. Cost inputs are represented by resource utilisation (number of units or staff time in minutes) and the cost of the unit/annual cost of the equipment. Resource utilisations for equipment and consumables inputs presented here are rounded to the nearest whole number. Furthermore, cost inputs are constituted by consumables, equipment, and staff. Information pertaining to the cost inputs is presented in the right hand column of the corresponding cost inputs
  2. GB: Great Britain; HPLC: high performance liquid chromatography; NaCl; sodium chloride; N/A: not applicable; PFS: pre-filled syringes; QA: quality assurance; UV-vis: ultraviolet-visible spectroscopy