JMIR Publications

ABSTRACT

Background:

The administration of drugs in pediatric emergency care is a time-consuming process and is associated with a higher occurrence of medication errors compared to adult care. This is attributed to the intricacies of administration, which involve calculating a weight-doses based on the child’s weight. To mitigate the occurrence of adverse drug events (ADE), the PedAMINES mobile app has been developed. This app is designed to offer a step-by-step guide for preparing and administering pediatric drugs during emergency interventions. It achieves this by automating the dose calculation process. Although prior simulation-based randomized controlled trials conducted in emergency care has demonstrated the efficacy of PedAMINES in reducing drug administration errors, there is a lack of evidence regarding its economic implications.

Objective:

Evaluate the cost-effectiveness of implementing the PedAMINES app for four emergency drugs: epinephrine, norepinephrine, dopamine, and midazolam.

Methods:

The economic evaluation was conducted by combining hospital data from 2019, prior trial outcomes, information extracted from existing literature, and PedAMINES maintenance costs. We first calculated the cost per avoided medication error, along with determining the number of administrations needed to achieve a positive return on investment (ROI). Subsequently, Monte Carlo simulations were employed to identify the key parameters that contribute to result uncertainty.

Results:

The study revealed the number of preventable errors per administration for the four examined drugs: 0.513 for epinephrine, 0.484 for norepinephrine, 0.500 for dopamine, and 0.671 for midazolam. The cost-effectiveness ratios per ADE prevented were computed as follows: USD 4’808 for epinephrine, USD 9’705 for norepinephrine, USD 6’957 for dopamine, and USD 2’074 for midazolam. Accounting for the economic impact of ADEs, the analysis estimated that 16 administrations of epinephrine, 17 of norepinephrine and dopamine, and 13 of midazolam would be required to attain a positive ROI. This corresponds to roughly one-third of the annual administrations at a major university hospital in Switzerland. The primary factors influencing the uncertainty in the estimated cost per ADE include the cost of maintenance of the app, the likelihood of an ADE resulting from an administration error, and the frequency of underdosing in the trial’s control group.

Conclusions:

A dedicated mobile app presents an economically viable solution to alleviate the health and economic burden of drug administration errors in in-hospital pediatric emergency care. The authors advocate for the widespread adoption of this app to pool costs and extend the benefits on a national scale in Switzerland.