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Review
. 2026 Jan 14.
doi: 10.1111/anae.70122. Online ahead of print.

Economic evidence for licensed ready-to-administer intravenous products compared with standard vials and ampoules: a systematic review

Suzanne Al-Rawi  1 , Matthew Greening  1 , Sue Ladds  1
Affiliations
Review

Economic evidence for licensed ready-to-administer intravenous products compared with standard vials and ampoules: a systematic review

Suzanne Al-Rawi et al. Anaesthesia. .

Abstract

Introduction: Injectable medicines represent a significant proportion of the annual medicines expenditure of the NHS in England, totalling £7 billion ($9.4 billion, €8.0 billion) in 2023. This represents approximately 70% of hospital medicines spending and includes essential treatments delivered at the point of care, such as chemotherapy; clinical trial drugs; and intravenous nutrition. Licensed ready-to-administer injectable products are manufactured and labelled for immediate use, eliminating the need for preparation or dilution by clinical staff, thereby enhancing efficiency and reducing risks. Despite the recognised benefits of ready-to-administer products for safety and productivity, most NHS hospitals favour traditional vials due to lower initial acquisition costs.

Methods: We searched for studies evaluating the clinical or economic impact of ready-to-administer intravenous medications in hospital settings. Grey literature from NHS and UK government sources was also reviewed. Inclusion criteria comprised English language studies assessing cost; waste; preparation time; or medication errors associated with ready-to-administer use.

Results: Sixteen studies were included in the review. Ready-to-administer products generally reduced preparation errors, drug wastage and preparation time, but variability in outcome measures and their definitions precluded meta-analysis. Evidence suggesting fewer adverse drug events and workflow interruptions derived mainly from observational studies and surrogate outcomes. Economic evaluations indicated potential savings from avoided errors, reduced waste and staff time, though estimates were context-specific and assumption-dependent. Overall, the risk of bias varied across studies and the predominance of small, single-centre, non-randomised designs limits generalisability.

Discussion: Licensed ready-to-administer products are associated with fewer preparation errors, shorter preparation times and reduced drug waste, with plausible economic benefits. The certainty of this conclusion is limited by heterogeneous, largely non-randomised designs and context-specific costs. Evidence specific to the UK is sparse. Multicentre studies with standardised outcomes and robust micro-costing are needed to define clinical impact, budget impact and implementation requirements.

Keywords: cost saving; drug errors; patient safety; ready to administer; sustainability.

Plain language summary

What we did: We looked at research studies to see how using ready‐to‐use injectable medicines works in hospitals. These are medicines that come already mixed and labelled, so staff do not need to prepare them. We also checked reports from the NHS and the UK government. In total, we reviewed 16 studies.

Why did we do it: Injectable medicines cost the NHS a lot of money and are very important for patient care. Ready‐to‐use medicines can save time and reduce mistakes, but many hospitals still use traditional vials because they seem cheaper to buy. We wanted to find out if ready‐to‐use medicines really help save time, reduce waste, and improve safety.

What we found: Ready‐to‐use medicines helped reduce mistakes, save staff time, and cut down on wasted medicine. Some studies suggested they might also lead to fewer harmful drug problems, but the evidence was not strong. Studies showed there could be cost savings, but the results depended on the hospital and how the costs were counted. Most studies were small and done in just one hospital, so the results may not apply everywhere. Overall, ready‐to‐use injectable medicines seem safer and more efficient, but better and larger studies—especially in the UK—are needed to be sure.

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References

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