Cost-Effectiveness Analysis of Pediatric Prescribing Total Parenteral Nutrition Programin Queen Sirikit National Institute of Child Health (QIPT Program)

Abstract

Background: Prescribing total parenteral nutrition (TPN) is a complex process that carries a risk of medication errors. Queen Sirikit National Institute of Child Health has developed a pediatric TPN prescribing program to assist in calculations and provide alerts for appropriate formula selection. Objective: To evaluate the cost-effectiveness of Queen Sirikit National Institute of Child Health Intelligent Prescribing TPN program (QIPT Program) compared with the classical prescribing program, from the healthcare provider’s perspective. Methods: The study assessed effectiveness based on the reduction of medication errors in TPN orders, alongside an evaluation of TPN operational costs in pediatric wards at the Queen Sirikit National Institute of Child Health during fiscal years 2019–2021. The cost analysis included three components: 1) TPN production cost, calculated using the conventional method, 2) TPN prescribing and administration cost, calculated using activity-based costing, and 3) development cost of the QIPT Program, calculated using activity-based costing. Results: The operational cost per TPN bottle using the QIPT Program and the classical program was 1,120.75 THB and 1,124.44 THB, respectively. The percentage reduction in medication errors with the QIPT Program compared with the conventional method was 85.37%, with a relative risk of 0.146, indicating a protective effect. The incremental cost-effectiveness ratio (ICER) was –33.58, meaning a cost saving of 33.58 THB per medication error prevented. Sensitivity analysis identified labor cost for TPN production as the key factor influencing cost-effectiveness. Conclusion: Compared with the classical program, the QIPT Program demonstrated a negative ICER, reflecting its effectiveness in reducing medication errors while incurring lower costs.