Aim To evaluate the cost-savings that could be made if prescribed oral liquid drugs were substituted with solid oral forms for children over 2 years of age, depending on dosage and size acceptability, in accord with EMEA guidelines.1
Method Anonymised pharmacy records of dispensed medicines in children over 2 years during one week were extracted from the drug dispensing software, Ascribe©. Substitution feasibility for each dispensed liquid medicine was determined following this process: (i) screening for the existence of a solid oral alternative, (ii) evaluating the acceptability of available solid oral forms, firstly related to the prescribed dose and secondly to acceptable size depending on children's age.1 Total costs were calculated using Ascribe© and Drug Tariff November 2012 respectively for the NHS and community perspectives. Cost differences corresponded to the potential cost benefits if oral liquid drugs dispensed during one week and having an acceptable solid form were substituted. Costs were calculated on the basis of providing treatment for 28 days for long term treatment and prescribed duration for short term treatment.
Results A total of 476 oral liquid formulations were dispensed in children over 2 years during one week. Sixty-one liquid formulations were unlicensed. Mean age of children receiving oral liquid drugs was 7.4±4.2 years. Almost 90% of liquid formulations were available as a solid form. Considering only solid form dosage acceptability, 79.6% of liquid formulations could be substituted with solid form. When additionally considering solid form size, 41% liquid formulations could be substituted. The total cost of oral liquid drugs dispensed during one week was £8,307 and £11,697 respectively from hospital and community prices. Drug cost-saving that could follow the substitution of oral liquid drugs with an acceptable solid form for dosage and size would be £4,951 and £8,550 respectively for hospital and community, corresponding to 60% and 73% of cost. By extrapolation, we can estimate projected annual saving at £238k and £410K, respectively for hospital and community costs.
Conclusion Whilst not all children over 2 years will be able to swallow tablets, this study has shown the importance of potential drug cost savings if oral liquid formulations were substituted with available solid form. Given the numerous advantages of solid forms compared to liquid formulations,2 this study may provide a theoretical basis for investing in modification of healthcare behaviours. Almost all oral liquid drugs were available as a solid form, and, surprisingly, in an acceptable dosage for the child's age. Costs are calculated on drug costs only. Estimating the costs of training children to take solid dosage forms is outside the scope of this study.
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