Evaluation of the cost saving achieved by centralising total parenteral nutrition compounding

Background Total parenteral nutrition (TPN) solutions are usually prepared by centralised compounding in the Pharmacy Department. Purpose To evaluate the cost saving achieved with centralised compounding of TPN solutions (newborns and adults) and product use optimisation in our Pharmacy Department. Materials and methods In order to calculate the number of TPN solutions and their cost, The authors studied preparation and dispensing on a single day. Data on the components of each TPN solution prepared were extracted from the software used for TPN compounding (MedicalOne ® Parenteral). Given the differences in composition, solutions were classified as adult and newborn. For each solution, two different costs were calculated: first the theoretical cost if each TPN solution was prepared separately in another clinical department (considering the cost of whole vials of each component, though in some cases only fractions were needed) and, second, the real cost of TPN solutions prepared in the Pharmacy Department (calculating costs per mililitre and volumes used of each component). The cost saving was calculated as the difference between the theoretical and the real cost of each TPN solution. The mean saving per patient was calculated for adults and for newborns. Results On the study day, 49 solutions were prepared: 33 for adults (oncology, 5; critical patients units, 13; surgery, 7; others, 8) and 16 for newborns (neonatology, 4; neonatal intensive care, 12). For adults, the mean cost was €39.53 per solution when prepared in clinical departments and €34.71 per solution when prepared in the Pharmacy department (mean cost saving, €4.82 (12.2%)). For newborns, the mean cost of TPN solutions was €24.71 per solution when prepared in clinical departments and €7.27 per solution when they were prepared in the Pharmacy Department (mean cost saving, €17.44 (70.6%)). Conclusions When TPN solutions are compounded centrally, significant cost savings are achieved, especially in newborns. Therefore, Hospital management should implement centralised compounding.