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Quantifying the cost of single-use minims and multidose bottles for eye drops in routine ophthalmic practice: a multicentre study

      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

        • Harte VJ
        • O'Hanrahan MT
        • Timoney RF
        Microbial contamination in residues of ophthalmic preparations.
        Int J Pharm. 1978; 1: 165-171
        • Nentwich MM
        • Kollmann K
        • Meshack J
        • Ilako DR
        • Schaller UC.
        Microbial contamination of multi-use ophthalmic solutions in Kenya.
        Br J Ophthalmol. 2007; 91: 1265-1268
        • Feghhi M
        • Zarei Mahmoudabadi A
        • Mehdinejad M
        Evaluation of fungal and bacterial contaminations of patient-used ocular drops.
        Med Mycol. 2008; 46: 17-21
        • Razooki RA
        • Saeed EN
        • Omar Al-Deem HI
        Microbial contamination of eye drops in outpatients in Iraq.
        IJPS. 2011; 20: 91-95
        • Teuchner B
        • Wagner J
        • Bechrakis NE
        • Orth-Höller D
        • Nagl M.
        Microbial contamination of glaucoma eye drops used by patients compared with ocular medications used in the hospital.
        Medicine (Baltimore). 2015; 94: e583
        • Tsegaw A
        • Tsegaw A
        • Abula T
        • Assefa Y.
        Bacterial contamination of multi-dose eye drops at Ophthalmology Department, University of Gondar, Northwest Ethiopia.
        Middle East Afr J Ophthalmol. 2017; 24: 81-86
        • 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: 1476-1479
        • Hanssens J
        • Quintana-Giraldo C
        • Jacques S
        • et al.
        Shelf life and efficacy of diagnostic eye drops.
        Optom Vis Sci. 2018; 95: 947-952
        • Rudnisky CJ
        • Wan D
        • Weis E.
        Antibiotic choice for the prophylaxis of post-cataract extraction endophthalmitis.
        Ophthalmology. 2014; 121: 835-841
      1. 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.

        • Uchio E
        • Ishiko H
        • Aoki K
        • Ohno S.
        Adenovirus detected by polymerase chain reaction in multidose eye drop bottles used by patients with adenoviral keratoconjunctivitis.
        Am J Ophthalmol. 2002; 134: 618-619
        • Muller MP
        • Siddiqui N
        • Ivancic R
        • Wong D.
        Adenovirus-related epidemic keratoconjunctivitis outbreak at a hospital-affiliated ophthalmology clinic.
        Am J Infect Control. 2018; 46: 581-583
        • Alai N.
        Enhancing best practices in ophthalmology for prevention of nosocomial epidemic keratoconjunctivitis infections.
        Curr Med Res Opin. 2016; 32: 1757-1758
        • Viney KA
        • Kehoe PJ
        • Doyle B
        • et al.
        An outbreak of epidemic keratoconjunctivitis in a regional ophthalmology clinic in New South Wales.
        Epidemiol Infect. 2008; 136: 1197-1206
        • Haripriya A
        • Chang DF
        • Ravindran RD.
        Endophthalmitis reduction with intracameral moxifloxacin prophylaxis: analysis of 600 000 surgeries.
        Ophthalmol (Rochester, MN). 2017; 124: 768-775
      2. 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).

        • Tauber J
        • Chinwuba I
        • Kleyn D
        • Rothschild M
        • Kahn J
        • Thiel CL.
        Quantification of the cost and potential environmental effects of unused pharmaceutical products in cataract surgery.
        JAMA Ophthalmol. 2019; 137: 1156-1163
        • Somner J
        • Cavanagh DJ
        • Wong K
        • Whitelaw M
        • Thomson T
        • Mansfield D.
        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
        • Rautenbach P
        • Wilson A
        • Gouws P.
        The reuse of Opthalmic Minims: an unacceptable cross-infection risk?.
        Eye. 2010; 24: 50-52
      3. ITSxPolicyAnalysis, GitHub, 2018; Available from: https://github.com/tonynick/ophthalmics (accessed August 18, 2020).

        • Jandoc R
        • Burden AM
        • Mamdani M
        • Lévesque LE
        • Cadarette SM.
        Interrupted time series analysis in drug utilization research is increasing: systematic review and recommendations.
        J Clin Epidemiol. 2015; 68: 950-956
        • Penfold RB
        • Zhang F.
        Use of interrupted time series analysis in evaluating health care quality improvements.
        Acad Pediatr. 2013; 13: S38-S44
        • Wagner AK
        • Soumerai SB
        • Zhang F
        • Ross-Degnan D.
        Segmented regression analysis of interrupted time series studies in medication use research.
        J Clin Pharm Ther. 2002; 27: 299-309
        • Tamer HR
        • Sweet BV
        • Ross MB.
        Use and sterility of multidose ophthalmic medications.
        Am J Health Syst Pharm. 1994; 51: 500-502