Abstract
Objective
To compare costs between two different eye drop delivery modalities: multidose bottles
and single-use minims.
Design
Retrospective cohort study.
Methods
Monthly dilating eye drop costs and quantities (tropicamide 1%, phenylephrine 2.5%,
cyclopentolate 1%) were studied over a 2-year period between April 2013 and March
2015 at 2 tertiary ophthalmic centres (Royal Alexandra Hospital [RAH, Edmonton] and
Rockyview General Hospital [RGH, Calgary]). In April 2014, RAH switched its dilating
eye drop practice from predominantly multidose bottles to single-use minims, whereas
RGH continued using predominantly multidose bottles. Eye drop volume and total and
per-patient eye drop costs were quantified at RAH before switching (pre-intervention)
and after (post-intervention) using an interrupted time-series analysis with RGH as
a control. A counterfactual analysis was also performed. Significance was obtained
using independent t-testing.
Results
After switching to single-use minims, RAH experienced changes in the following: an
increase in single-use minims as a proportion of total eye drop utilization (from
5.6% to 89.1%; p = 0.001), an increase in total eye drop cost by $2117 per month (95% confidence interval
[CI], $1354–$2880; p < 0.001), an increase in per-patient costs by $984 per 1000 patients per month (95%
CI, $674–$1293). Contrastingly, RGH did not experience similar changes. Ultimately,
the cost of switching to single-use minims was $22 481 (95% CI, $7830–$31 336) over
a 12-month period.
Conclusions
If safe eye drop practices are enforced via proper protocols, the use of multidose
bottles may be a more cost-effective option than single-use minims for routine clinical
practice.
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References
- Microbial contamination in residues of ophthalmic preparations.Int J Pharm. 1978; 1: 165-171
- Microbial contamination of multi-use ophthalmic solutions in Kenya.Br J Ophthalmol. 2007; 91: 1265-1268
- Evaluation of fungal and bacterial contaminations of patient-used ocular drops.Med Mycol. 2008; 46: 17-21
- Microbial contamination of eye drops in outpatients in Iraq.IJPS. 2011; 20: 91-95
- Microbial contamination of glaucoma eye drops used by patients compared with ocular medications used in the hospital.Medicine (Baltimore). 2015; 94: e583
- Bacterial contamination of multi-dose eye drops at Ophthalmology Department, University of Gondar, Northwest Ethiopia.Middle East Afr J Ophthalmol. 2017; 24: 81-86
- Using multidose eye drops in a health care setting: a policy and procedural approach to safe and effective treatment of patients.JAMA Ophthalmol. 2014; 132: 1476-1479
- Shelf life and efficacy of diagnostic eye drops.Optom Vis Sci. 2018; 95: 947-952
- Antibiotic choice for the prophylaxis of post-cataract extraction endophthalmitis.Ophthalmology. 2014; 121: 835-841
Jensen MK, Nahoopii R, Johnson B. Using multidose eye drops in a health care setting: a policy and procedural approach to safe and effective treatment of patients. JAMA Ophthalmol 2014;132(Suppl):eAppendix 1-eAppendix 2.
- Adenovirus detected by polymerase chain reaction in multidose eye drop bottles used by patients with adenoviral keratoconjunctivitis.Am J Ophthalmol. 2002; 134: 618-619
- Adenovirus-related epidemic keratoconjunctivitis outbreak at a hospital-affiliated ophthalmology clinic.Am J Infect Control. 2018; 46: 581-583
- Enhancing best practices in ophthalmology for prevention of nosocomial epidemic keratoconjunctivitis infections.Curr Med Res Opin. 2016; 32: 1757-1758
- An outbreak of epidemic keratoconjunctivitis in a regional ophthalmology clinic in New South Wales.Epidemiol Infect. 2008; 136: 1197-1206
- Endophthalmitis reduction with intracameral moxifloxacin prophylaxis: analysis of 600 000 surgeries.Ophthalmol (Rochester, MN). 2017; 124: 768-775
American Society of Cataract and Refractive Surgery. ASCRS releases position statement on two established ophthalmic practices, 2015; Available from: www.ascrs.org/node/23265 (accessed August 24, 2020).
- Quantification of the cost and potential environmental effects of unused pharmaceutical products in cataract surgery.JAMA Ophthalmol. 2019; 137: 1156-1163
- The precautionary principle: what is the risk of reusing disposable drops in routine ophthalmology consultations and what are the costs of reducing this risk to zero?.Eye. 2010; 24: 361-363
- The reuse of Opthalmic Minims: an unacceptable cross-infection risk?.Eye. 2010; 24: 50-52
ITSxPolicyAnalysis, GitHub, 2018; Available from: https://github.com/tonynick/ophthalmics (accessed August 18, 2020).
- Interrupted time series analysis in drug utilization research is increasing: systematic review and recommendations.J Clin Epidemiol. 2015; 68: 950-956
- Use of interrupted time series analysis in evaluating health care quality improvements.Acad Pediatr. 2013; 13: S38-S44
- Segmented regression analysis of interrupted time series studies in medication use research.J Clin Pharm Ther. 2002; 27: 299-309
- Use and sterility of multidose ophthalmic medications.Am J Health Syst Pharm. 1994; 51: 500-502
Article Info
Publication History
Published online: July 17, 2021
Accepted:
June 6,
2021
Received in revised form:
June 2,
2021
Received:
April 14,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
