Intravenous Therapy Error Reduction Systems: A Cost-Effectiveness Analysis of Two Available Solutions versus Gravity Infusion in South Africa. (Preprint)

Abstract

In the Republic of South Africa smart infusion technologies are poorly adopted across health systems due to the sizeable capital spends for equipment, and the higher cost of disposables versus gravity infusion.

We illustrate the estimated costs and expected effectiveness of gravity infusion and alternatives, and identify the Incremental Cost-Effectiveness Ratio between the respective solutions given the risks of wrong patient-wrong IV-medication and dose/rate errors, harm from infusion injuries, and workflow impacts on nursing time.

The techniques assessed were: Gravity infusion administration. Volumetric Pump with safety software. Barcode Medication Administration and Volumetric Pump with safety software. The study took a healthcare system perspective. Patient harm events were expressed as incidence rates per 10,000 infusions. Infusion therapy undertaken in general adult environments was assessed.

There are substantial hidden costs related to harm associated with gravity infusion. Gravity infusion is very labor intensive. Volumetric Pumps with safety software, and barcode medication administration with smart pump technology fall very closely around an ICER of 1.0 even using the most conservative measures of harm and efficiency loss.

There is no other study in the literature with the scope or transferability of the current study. The study is generalizable as it does not assume ideal conditions. The results might give less clarity on the value of investment in technologies beyond the do-nothing option in very low-wage healthcare systems, but the technologies’ benefits for patients and healthcare workers might qualify them as ‘higher cost-high impact’ solutions.

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