The Association between Needle Size and Waste Product and Its Effect on Cost-Effectiveness of Botulinum Toxin Injections?
Clostridium botulinum toxin (BT) must be administered intramuscularly with a syringe, but dead space in the syringe–needle complex may cause product waste and result in cost implications for the patient and provider. Syringe dead space is the volume of residual fluid that remains within the syringe after the plunger is fully depressed during medication injection. We calculated the average volume of remaining product in a syringe–needle complex and cost loss implication of this volume of BT. This is a single-center, analytical study using saline and four different sized needles for analytics of waste product and cost-effectiveness. Syringes of 1 mL with attached 18, 21, 30, and 32-gauge (G) needles, respectively, were compared. The syringe–needle complex was weighed before drawing 0.05 mL of saline. The fluid was then discarded with the appropriate syringe and then weighed again. This procedure was repeated for the four needle types and the average difference in weight of the syringe–needle complex before and after saline waste was measured. The volume was converted to units of BT used in clinical practice and the cost of waste product evaluated. The mean difference in needle–syringe complex weight before and after intervention was 0.068, 0.056, 0.04, and 0.026 g for the 18, 21, 30, and 32G needles, respectively. We found a statistically significant difference comparing the 18G with the 30 and 32G (0.02 and 0.0007, respectively) and comparing the 21G with the 30 and 32G (0.0042 and 0.00002, respectively). When we extrapolated the data to BT units (4U/0.1 mL), we found that theoretically 2.72, 2.24, 1.6, and 1.04 units of BT are left in the syringe–needle complex for the 18, 21, 30, and 32G syringes, respectively. At a cost of $6.01/U of onabotulinum toxin A, we then calculated a provider loss of a gross average (mean) revenue of $96 and 62.4 per 10 syringes used with 30 and 32G needles. Needle size used for drawing up and administering BT has an effect on the amount of waste product and subsequently on cost-effectiveness.
20 July 2020 (online)
© 2020. Thieme. All rights reserved.
Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.
- 1 Hexsel D, Brum C, do Prado DZ. , et al. Field effect of two commercial preparations of botulinum toxin type A: a prospective, double-blind, randomized clinical trial. J Am Acad Dermatol 2012; 67 (02) 226-232
- 2 Plastic Surgery Procedural Statistics 2016. American Society of Plastic Surgeons [website]. Available at: http://plasticsurgery.org/news/plastic-surgery-statistics/2014-plastic-surgery-statistics.html . Accessed March 16, 2017
- 3 Jarrahian C, Rein-Weston A, Saxon G. , et al. Vial usage, device dead space, vaccine wastage, and dose accuracy of intradermal delivery devices for inactivated poliovirus vaccine (IPV). Vaccine 2017; 35 (14) 1789-1796
- 4 Dead Space Cost Containment [US Medical Instruments Incorporated Web site]. Available at: http://usmedicalinstruments.com . Accessed March 16, 2017
- 5 Oramasionwu CU, Cole AL, Dixon MS. , et al. Estimated cost of injectable medication waste attributable to syringe dead space. JAMA Intern Med 2016; 176 (07) 1025-1027
- 6 Bach PB, Conti RM, Muller RJ, Schnorr GC, Saltz LB. Overspending driven by oversized single dose vials of cancer drugs. BMJ 2016; 352: i788
- 7 Zule WA, Ticknor-Stellato KM, Desmond DP, Vogtsberger KN. Evaluation of needle and syringe combinations. J Acquir Immune Defic Syndr Hum Retrovirol 1997; 14 (03) 294-295
- 8 Berne C, Agenäs I, Eriksson G, Wibell L. Insulin wastage in ambulant practice. Diabetes Care 1984; 7 (04) 343-346
- 9 Shainfeld FJ. Errors in insulin doses due to the design of insulin syringes. Pediatrics 1975; 56 (02) 302-303
- 10 Foglietti MA, Wright L, Foglietti-Fostyk A. Botulinum toxin therapy: is syringe type related to cost-effectiveness?. Ann Plast Surg 2018; 80 (03) 287-289
- 11 Solinsky R, Kirshblum SC. Quantifying and Reducing Retained Botulinum Toxin Postinjection. PM R 2018 ;S1934–1482(18)30360–5 [epub ahead of print] Doi: 10.1016/j.pmrj.2018.06.010
- 12 Allergan, Inc. Botox Cosmetic (onabotulinum toxin A) for Injection (Full Prescribing Information). Irvine, CA: Allergan, Inc; 2009
- 13 10 Botox® Techniques and Tips for Awesome Results. International Association for Physicians in Aesthetic Medicine [website]. Available at: https://iapam.com/10-botox-techniques-and-tips-for-awesome-results.html . Accessed June 16, 2020