Il dimensionamento ottimale delle Unità Farmaci Antiblastici in condizioni di efficienza gestionale

Introduction The Recommendation n. 14 of 2012 of Ministry of Health, regarding the prevention of errors in therapy, in the oncological sector, provides for the institution of a Centralized Unit for cytotoxic drug or the possibility to make covenants with others hospitals where the compounding is made in a centralized way.This study aims to define a methodology to detect reference standard about technological sizing (manual or robotic workstations) and number of professionals working in the Centralized Unit for cytotoxic drug. Materials and Methods A specific model has been made in order to simulate scenarios of sizing based on structural and organizational features, and activities defined by the users. The model allows, in particular, to determine the medium cost of a cytotoxic compound, depending on configuration of Centralized Unit for cytotoxic drug adopted, by defining a reference value or standard cost helpful to regulate the covenants between hospitals. Results Evidently, by increasing the number of compounds the needs in terms of personnel and technologies increases: the simulation model, based on hypothesis described, estimated for the minimum sizing, until 90 compounds per die, 1 pharmacist and 2 technicians/nurses. The maximum one, expected per 230-250 compounds per die was of 3 pharmacists and 7 technicians/nurses; in terms of technological sizing it moved from 1 workstation until 90 compounds per die to 3 when the number of compounds became double. Regarding the compound’s cost there were potential important economies of scale: from € 15.6 with 1 workstation and about 80 compounds per die, to € 13.8 (-11.5%) with 2 workstations and about 160 compounds per die, until € 13.2 (-15.4) with 3 workstations and 230 compounds per die. Conclusions The results obtained through the simulation model agree with the quantitative data reported in regulations, available to date, by ensuring about the correctness of scenarios. They could represent a standard to support the regional and local health planning by allowing an optimal management of centralized compounding of cytotoxic therapies, by ensuring the maximum efficiency.