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Ms. Beissel says the Surgical Institute of Reading has a "very active" Supply Value Analysis Committee to evaluate monthly the high-dollar items for possible cost savings. In most cases, she says, using multi- dose vials per patient has proven to be the most cost-effective option, despite an "excessive" amount of wastage. An example is a medica- tion that is dispensed in a 20 ml vial and the usual dose for an individ- ual patient is 2 ml. "This translates into an 18 ml waste," she says. "Obviously if you can get this medication in a 2 ml vial or syringe, that would make sense, but if the 2 ml vial costs twice as much as the 20 ml vial, the best case for the patient is to get the larger quantity and unfortunately waste it." Medication wastage is a big concern, she says, because "there are many people who do not have access to the medications we are dis- carding." Another cost consideration with using prefilled syringes is their 90- day shelf life. Most medications in vials have a much longer shelf life, many times a year or more. Even so, Mr. Sones believes "it's a matter of being aware of that and responding to it." "Facilities can order in a carefully monitored and calculated way to accommodate the shorter expiration dates," he says. "At the end of the day, the elimination of wastage and avoiding some of the safety concerns far outweigh any potential drawbacks." How much are you wasting? Analyzing how much medication you waste might be a good place to start, says Mr. Karwoski. Such a thorough analysis, he suspects, might reveal how prefilled syringes could help you gain back the dollar amount attributed to the wastage, despite prefilled syringes' higher cost per ml. "If you can't go to your board and say, 'This [prefilled] syringe is $6; it's a little more money, but we'll be wasting less,' analyze it in a broader 1 0 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J a n u a r y 2 0 1 7