Background: Vancomycin is a widely used glycopeptide antibiotic, especially for treating severe gram-positive infections in home infusion therapy. Healthcare systems are increasingly focused on balancing cost efficiency with high-quality care. One area of interest is the choice between using premixed vancomycin products, which offer convenience and standardization, versus compounded formulations, which can be tailored to specific patient needs and might involve lower material costs. The objective of this study is to conduct a cost-minimization analysis to compare the overall costs of these two approaches in the home infusion setting.
Purpose: Vancomycin is a commonly used glycopeptide antibiotic, which is effective in treating severe gram-positive infections in home infusion therapy (HIT). This study aims to compare the overall costs of premixed vancomycin products versus compounded formulations through a cost minimization analysis in the home infusion setting.
Methods: A retrospective analysis was conducted using a 12 month sample of vancomycin patients from Hammonton NJ, Horsham PA, and Edison NJ, from October 31, 2023, to November 1, 2024. A real time component of the study assessed cost differences by factoring in drug pricing, labor, and nursing costs, including expenses related to extra visits and lab draws.To calculate the costs associated with compounded vancomycin, an Excel sheet was used to track expenses for materials. Each order was documented with a detailed worksheet outlining material quantities, direct costs, and labor expenses. Calculations were based on wages of pharmacy technicians and pharmacists in Hammonton, who earned $27.97/hour ($0.47/min) and $71.56/hour ($1.19/min), respectively. Data was sourced from pharmacy records, personnel logs, and market pricing trends.
Results: The average total cost for a single compounded vancomycin work order was calculated to be $151.12, ranging in cost from $54.26-$263.60. In Hammonton, technician compounding time averaged 25 minutes per order versus pharmacists it was 33 minutes. For example, a 7-day supply of the 1.25g pre-mixed bag, the total cost would be approximately $166.58 (7 bags, 7 tubings, 10 red caps, and 1 pole) and for the 1g pre-mixed bags, the total cost would be $143.97. The cost average of orders fluctuated depending on the size of the vial and elastomeric ball, with a 1g vial and 100 mL elastomeric priced at $117.48, while a 10g vial with a 450mL elastomeric costing $255.38.
Discussion: Higher-cost orders were largely attributed to extra label printing, urgent stat orders, and reprocessing due to lot discrepancies. Premixed vancomycin proved more cost effective and time efficient, particularly in high-volume settings, where labor costs were relatively low. However, the increased frequency of abnormal trough levels and extra nursing visits indicated a more complex patient population, needing closer monitoring parameters. The similar rates of wasted doses in Hammonton and Edison highlight a need to focus on improving dose planning and administration. Amongst all sites, 30 extra nursing visits were needed, 24 in patients who were on elastomeric pumps versus 6 on premix formulations.
Conclusions: This study shows that premixed vancomycin is both cost and time efficient than compounded formulations, especially in high-volume settings. Although premixed products have shown to be more efficient in terms of preparation and associated labor costs, the complexity of patients at different sites affected the overall results. While premixed vancomycin products are a cost effective choice, it is essential to use a patient centered approach to fully optimize the benefits of HIT.
.jpg "Reem Moustafa, PharmD photo")