Presentation (CTI)

OBJECTIVES: To evaluate the real-world economic and healthcare-system value of hospital-compounded preparations in a Thai tertiary hospital using cost avoidance analysis and operational production data.
METHODS: A retrospective real-world economic evaluation was conducted from the hospital perspective using operational production, inventory, and institutional costing data from fiscal year 2025. A total of 56 compounded formulations representing approximately 85-86% of annual production volume were included across external, internal, sterile, antiseptic/disinfectant, and pediatric extemporaneous categories. Formulations were classified according to commercial market availability. Group A formulations with market comparators were analyzed quantitatively using standardized cost avoidance analysis, while Group B formulations without direct commercial equivalents were evaluated descriptively for healthcare access value. High-impact formulations underwent Time-Driven Activity-Based Costing (TDABC), while routine formulations utilized standardized institutional production cost records. Sensitivity analyses were performed using varying market price assumptions for selected high-impact products.
RESULTS: Group A formulations generated an estimated annual cost avoidance of approximately 7.78 million THB/year compared with commercial market alternatives. Major contributors included tar shampoo, 2% chlorhexidine in 70% alcohol, antiseptic handrub formulations, and Aqua gel products. Sensitivity analyses demonstrated persistent economic advantages across varying market price scenarios, supporting the robustness of economic outcomes. Several formulations demonstrated minimal or negative cost avoidance, supporting methodological neutrality. Group B formulations represented approximately 5.03 million THB/year in institutional pharmaceutical production expenditure supporting access to specialized and pediatric formulations without direct commercial market alternatives. Overall compounded pharmaceutical activity analyzed exceeded 12.8 million THB/year.
CONCLUSIONS: Hospital compounding generated substantial dual value within a tertiary healthcare system through both measurable economic savings and maintenance of access to essential formulations unavailable in the commercial market. These findings support hospital compounding as a strategic healthcare service contributing to economic sustainability, continuity of care, and healthcare-system resilience in resource-constrained settings.