Return on investment and financial sustainability of pharmacy automation systems in healthcare: a systematic review

Objectives This systematic review aims to evaluate the return on investment (ROI) and financial sustainability of pharmacy automation systems in healthcare settings. Methods PubMed, Scopus, ScienceDirect, and Google Scholar were searched for peer-reviewed studies, with the search updated through 1 February 2026. Eligible studies compared pharmacy automation with manual or pre-automation workflows and reported ROI, cost savings, resource use, or budget impact. Due to heterogeneity in study design, economic perspective, and outcome reporting, findings were synthesized qualitatively. Key findings Of 898 non-duplicate articles, nine studies met the inclusion criteria. Pharmacy automation was generally associated with favourable financial and operational outcomes, although economic reporting was heterogeneous. Reported financial outcomes included positive ROI estimates, net benefits of up to US$3.49 million over five years, net present value of approximately US$566344 (€510 404) over five years, annual medication-related savings of up to US$4.1 million, and payback or break-even periods ranging from within one year to approximately eight years. Automation was also associated with reduced medication waste, expired stock, and adverse drug event-related costs. Changes in staff time utilization and productivity were reported, including reduced time spent on selected medication-related activities and reallocation of staff toward other clinical tasks. These time efficiencies did not necessarily represent direct reductions in staffing expenditure. Conclusions Available evidence suggests that pharmacy automation can be associated with favourable financial and operational outcomes in some healthcare settings. However, the generalizability of these findings is limited by heterogeneity in system costs, institutional contexts, and the potential for publication and implementation selection bias.