Archive May 2018 XIX, No. 5

Calculating the Cost of Prefilled Syringes

Go drug by drug to see if it's time to make the switch.

John Karwoski

John Karwoski, RPh, MBA


PRICE OF PREFILLED You'll almost always pay more for premixed, prelabeled syringes, but you'll waste less medication — and you'll spend less time drawing it up and labeling it.

The biggest roadblock I face when approaching administrators of surgery centers about prefilled syringes is the price point compared to vials. I get it. My clients don't know what goes on behind the scenes at a 503B compounding facility that leads to the upcharge. It's unlikely they're going to take a day out of their busy schedules to go see how it's all done. But when you compare the cost between two items that serve the same purpose, do you only compare the upfront costs? Of course not. Deciding to make the switch from vials to prefilled syringes is no different.

The price of prefilled syringes is just one variable that should go into your calculation. I tell my clients to first look at all the drugs they buy as single-use vials or ampules and think about what goes into their use. I used to have our pharmacy director look in our trash cans to see what drugs we were throwing out. That's a good place to start to identify drugs that may be better off purchased in prefilled syringes.

  • Time. How much time do your nurses spend finding the vial of medication, grabbing the proper needle, drawing it up, labeling it and administering it to the patient? With a prefilled syringe, you just grab the syringe and administer the medication. This could be a huge time-saver, so you need to determine how much your staff's time is worth and include that in your calculation.
  • Waste. All vials accessed in the OR are single-use and many centers have adopted a policy to treat all of their vials, even multi-dose, as single-use. So you're always throwing away some medication that didn't make it into the syringe you just drew up. You spent $1 on that 10 mL vial of neostigmine, but you threw out 6 mL of it just now. How much did you waste? You paid for the whole vial and used less than half of it. You then have to factor in the costs of properly disposing of the unused medication. Do you buy disposable containers with chemicals that render the medication unusable or do you buy cartridges for a wall-mounted disposal system? Switching to prefilled syringes could reduce the number of containers or cartridges you need to purchase.
  • Materials. There's always the cost of syringes and needles to think about, but if you're drawing up medications from ampules you need to have a filtered needle. These extra materials need to make it into your cost considerations. You also need a dedicated space, away from patient care areas, to draw up the medications. Finding or creating that space takes resources and time that you need to consider.
  • Errors. Prefilled syringes can reduce the chance that a medication is drawn up incorrectly or not labeled properly and given to the wrong patient. There are many articles and statistics on medication errors and what they can cost your facility. It's definitely worth calculating how much the reduction in medication errors will save you.
  • Shipping costs. Another reason you need to do this calculation drug-by-drug is to look at your usage patterns so you place your orders strategically. When you buy prefilled syringes, the beyond use date (BUD) may be shorter than the vial form. For example, neostigmine has a BUD after 18 months in vial form but prefilled syringes of the drug need to be used in 60-90 days.
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