ต้นทุนประสิทธิผลของการใช้น้ำเกลือ 0.9% แบบสำเร็จรูปเปรียบเทียบกับการเตรียมเองในการหล่อเข็มฉีดยาชนิดล็อกสำหรับผู้ป่วยที่รักษาตัวในโรงพยาบาล

Jiraporn Khumsri; Kanokporn Suvapanich

Authors

Jiraporn Khumsri Nopparat Rajathanee Hospital
Kanokporn Suvapanich Nopparat Rajathanee Hospital

Keywords:

cost-effectiveness analysis, normal saline, prefilled syringe, peripheral intravenous catheter, contamination

Abstract

Background: Peripheral intravenous administration of medications or fluids is one of the most commonly performed procedures approximately 32–48% of hospitalized patients. Peripheral intravenous devices are often converted to indwelling catheters and flushed intermittently with 0.9% sodium chloride solution (normal saline) to maintain patency and reduce unnecessary fluid administration. Sterile normal saline is required for this purpose. Manual saline preparation involves multiple steps, increasing the risk of microbial contamination. Recently, ready-to-use normal saline syringes have been introduced to reduce preparation steps, although they are associated with higher costs.

Objective: To analyze the cost-effectiveness in terms of contamination prevention using a fluorescent substance as a surrogate marker for microorganisms, comparing ready-to-use prefilled normal saline syringe with manually prepared normal saline syringe.

Methods: A decision tree model was constructed from the healthcare provider perspective with a one-year time horizon. For the manual preparation, costs included medical supplies and nursing labor costs required for preparation. For the ready-to-use option, only equipment costs were considered. Effectiveness outcomes were measured by the rate of fluorescent contamination during preparation, derived from a clinical experimental study.

Results: The manually prepared normal saline syringe showed a fluorescent contamination rate of 46.7%, whereas no contamination (0%) was detected in the ready-to-use syringe group. Annual cost analysis revealed that the total cost for ready-to-use prefilled syringes was 213,853.5 THB, while the manually prepared method ranged from 229,128.75 to 297,867.38 THB. The incremental cost-effectiveness ratio (ICER) indicated that an additional cost of 2–10 THB could reduce 1 contamination event.

Conclusion: An additional cost of 2–10 THB is required from using ready-to-use normal saline syringes compared to using manual preparation to prevent one intravenous contamination.

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