1
|
Rahimi H, Goudarzi R, Markazi-Moghaddam N, Nezami-Asl A, Zargar Balaye Jame S. Cost-benefit analysis of Intensive Care Unit with Activity-Based Costing approach in the era COVID-19 pandemic: A case study from Iran. PLoS One 2023; 18:e0285792. [PMID: 37192194 DOI: 10.1371/journal.pone.0285792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/29/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Providing intensive care to acute patients is a vital part of health systems. However, the high cost of Intensive Care Units (ICU) has limited their development, especially in low-income countries. Due to the increasing need for intensive care and limited resources, ICU cost management is important. This study aimed to analyze the cost-benefit of ICU during COVID-19 in Tehran, Iran. METHODS This cross-sectional study is an economic evaluation of health interventions. The study was conducted in the COVID-19 dedicated ICU, from the provider's point of view and within one-year horizon. Costs were calculated using a top-down approach and the Activity-Based Costing technique. Benefits were extracted from the hospital's HIS system. Benefit Cost ratio (BCR) and Net Present Value (NPV) indexes were used for cost-benefit analysis (CBA). A sensitivity analysis was performed to evaluate the dependence of the CBA results on the uncertainties in the cost data. Analysis was performed with Excel and STATA software. RESULTS The studied ICU had 43 personnel, 14 active beds, a 77% bed occupancy rate, and 3959 occupied bed days. The total costs were $2,372,125.46 USD, of which 70.3% were direct costs. The highest direct cost was related to human resources. The total net income was $1,213,314.13 USD. NPV and BCR were obtained as $-1,158,811.32 USD and 0.511 respectively. CONCLUSION Despite operating with a relatively high capacity, ICU has had high losses during the COVID-19. Proper management and re-planning in the structure of human resources is recommended due to its importance in the hospital economy, provision of resources based on needs assessment, improvement of drugs management, reduction of insurance deductions in order to reduce costs and improve ICU productivity.
Collapse
Affiliation(s)
- Hamed Rahimi
- Department of Health Management and Economics, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Reza Goudarzi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Nader Markazi-Moghaddam
- Department of Health Management and Economics, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Amir Nezami-Asl
- Faculty of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Sanaz Zargar Balaye Jame
- Department of Health Management and Economics, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Aziz A, O'Donnell H, Harris DG, Jung HS, DiMusto P. Evaluation of a Standardized Protocol for Medical Management of Uncomplicated Acute Type B Aortic Dissection. J Vasc Surg 2022; 76:639-644.e2. [PMID: 35550395 DOI: 10.1016/j.jvs.2022.03.882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The goals of medical management for uncomplicated acute type B aortic dissection are to prevent expansion of the false lumen and malperfusion syndrome. This is accomplished with antihypertensive agents, but medication selection and titration are typically provider dependent. Given the paucity of data on evidence-based management of this population, we hypothesized that a standardized type B aortic dissection medical management protocol would reduce resource utilization and costs, without compromising patient outcomes. METHODS A multidisciplinary team developed a goal-directed protocol to standardize the medical management of uncomplicated acute type B aortic dissection, with an emphasis on early initiation of oral medications, weaning of anti-hypertensive infusions and frequent assessment for de-escalation of care. Implementation was in April 2018. A retrospective review of acute type B aortic dissection patients presenting to our institution from April 2016- April 2020 was performed. Patients requiring aortic or peripheral intervention were excluded. Included patients were analyzed based on treatment before or after protocol implementation. Patient demographics, systolic blood pressure, presence of acute kidney injury at presentation, length of stay, cost metrics, and 30-day mortality were compared. RESULTS 39 patients were included, 21 pre- and 18 post-protocol implementation. Baseline demographics, systolic blood pressure, and presence of acute kidney injury at presentation were similar between the groups. Post-protocol patients had shorter total (8.6 vs 5.5 days, p=.02) and intensive care unit (3.2 vs 1.8 days, p=.002) length of stay. The protocol was associated with significantly decreased total hospital ($38,928 vs $28,066, p=.04), total variable ($23,115 vs $15,627, p=0.02), and pharmacy ($5,094 vs $1,181, p<.001) costs, while inpatient care costs ($15,152 vs $11,467, p=.09) trended down. Post-protocol patients required fewer oral antihypertensive agents at discharge (3.8 vs 2.7, p=.005). No significant difference in 30-day mortality was observed. CONCLUSIONS A goal directed protocol reduces resource utilization and costs without compromising early mortality rates for patients with uncomplicated acute type B aortic dissection. Such a strategy may have broader application in medical management of acute aortic syndromes.
Collapse
Affiliation(s)
- Antony Aziz
- University Of Wisconsin- Department of Surgery.
| | | | | | | | | |
Collapse
|
3
|
Janatolmakan M, Khatony A. Explaining the consequences of missed nursing care from the perspective of nurses: a qualitative descriptive study in Iran. BMC Nurs 2022; 21:59. [PMID: 35287687 PMCID: PMC8918588 DOI: 10.1186/s12912-022-00839-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Missed nursing care is a global challenge that can have many consequences. Knowing the experiences of clinical nurses can be helpful. Therefore, this study was conducted to explain the experiences of Iranian nurses regarding the consequences of missed nursing care. Methods This qualitative descriptive study was conducted with a content analysis approach. Sampling was done by the purposeful sampling method and continued until data saturation. Data were collected by in-depth semi-structured interviews. Data were analyzed using qualitative content analysis and Graneheim and Lundman’s method. MAXQDA version 10 software was used for data management. Results The participants included 14 nurses with a mean age of 38.7 ± 7.7 years. The data were classified into three categories: patient-related outcomes, nurse-related outcomes, and organization-related outcomes. These categories included nine subcategories entitled "moral distress", "job dissatisfaction", " decreased quality of nursing care "," patient dissatisfaction ","adverse events"," absenteeism ","intention to leave and subsequent turnover", "decreased hospital credit", and "increased hospital costs". Conclusion Missed nursing care can have adverse consequences for the patients, nurses, and organizations. Therefore, it is necessary to adopt management strategies such as providing sufficient manpower and increasing nurses' job satisfaction to reduce the amount of missed nursing care. Further studies are needed to explain the predictors of the missed nursing care consequences.
Collapse
Affiliation(s)
- Maryam Janatolmakan
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran. .,Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| |
Collapse
|
4
|
Tadrous M, Daniels B, Pearson SA, Gomes T. Comparison of claims from high-drug cost beneficiaries in Ontario, Canada, and Australia: a cross-sectional analysis. CMAJ Open 2021; 9:E1048-E1054. [PMID: 34815260 PMCID: PMC8612656 DOI: 10.9778/cmajo.20200291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Globally, payers are struggling with rising drug costs, driven primarily by the increasing number of high-cost medications used by their beneficiaries. We aimed to compare the annual drug spending on claims from high-drug cost beneficiaries in the province of Ontario, Canada, and Australia. METHODS We conducted a cross-sectional analysis of public drug claims in Ontario and Australia from fiscal years 2006 to 2017. We identified the total government costs for prescribed medications per beneficiary. During the study period, public drug coverage in Ontario was provided to all residents 65 years of age and older, those with financial needs, and those living in long-term care or in need of home care. Australia maintains a publicly funded, universal system covering all citizens. Based on annual spending, we divided beneficiaries into 4 cost groups, representing the top 1%, top 5%, top 10% and the remaining 90%. We reported the following for each cost group: medication cost and proportion of total government spending, number of unique drugs dispensed per person and the top 10 most costly drug classes. RESULTS In Ontario and Australia, the top 1% of beneficiaries accounted for a large and increasing proportion of all government drug costs, growing from 12% ($405 946 197) to 24% ($1 345 977 248) in Ontario, and from 14% ($86 565 586) to 34% ($416 097 984) in Australia between 2006 and 2017. The most costly drug classes among high-drug cost beneficiaries in both jurisdictions were biologics and hepatitis C treatments. INTERPRETATION In both Ontario and Australia, a small number of beneficiaries accounted for a large proportion of public drug spending, driven largely by the use of expensive medications. The current development of potential national pharmacare strategies in Canada must optimize the use of high-cost drugs to ensure the sustainability of the program.
Collapse
Affiliation(s)
- Mina Tadrous
- Leslie Dan Faculty of Pharmacy (Tadrous, Gomes), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital; ICES Central (Tadrous, Gomes), Toronto, Ont.; Medicines Policy Research Unit (Daniels, Pearson), Centre for Big Data Research in Health, UNSW Sydney; Menzies Centre for Health Policy (Pearson), University of Sydney, New South Wales, Australia; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Gomes), University of Toronto, Toronto, Ont.
| | - Benjamin Daniels
- Leslie Dan Faculty of Pharmacy (Tadrous, Gomes), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital; ICES Central (Tadrous, Gomes), Toronto, Ont.; Medicines Policy Research Unit (Daniels, Pearson), Centre for Big Data Research in Health, UNSW Sydney; Menzies Centre for Health Policy (Pearson), University of Sydney, New South Wales, Australia; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Sallie-Anne Pearson
- Leslie Dan Faculty of Pharmacy (Tadrous, Gomes), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital; ICES Central (Tadrous, Gomes), Toronto, Ont.; Medicines Policy Research Unit (Daniels, Pearson), Centre for Big Data Research in Health, UNSW Sydney; Menzies Centre for Health Policy (Pearson), University of Sydney, New South Wales, Australia; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy (Tadrous, Gomes), University of Toronto; Women's College Research Institute (Tadrous), Women's College Hospital; ICES Central (Tadrous, Gomes), Toronto, Ont.; Medicines Policy Research Unit (Daniels, Pearson), Centre for Big Data Research in Health, UNSW Sydney; Menzies Centre for Health Policy (Pearson), University of Sydney, New South Wales, Australia; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Gomes), University of Toronto, Toronto, Ont
| |
Collapse
|
5
|
Abstract
OBJECTIVES To provide a multiorganizational statement to update recommendations for critical care pharmacy practice and make recommendations for future practice. A position paper outlining critical care pharmacist activities was last published in 2000. Since that time, significant changes in healthcare and critical care have occurred. DESIGN The Society of Critical Care Medicine, American College of Clinical Pharmacy Critical Care Practice and Research Network, and the American Society of Health-Systems Pharmacists convened a joint task force of 15 pharmacists representing a broad cross-section of critical care pharmacy practice and pharmacy administration, inclusive of geography, critical care practice setting, and roles. The Task Force chairs reviewed and organized primary literature, outlined topic domains, and prepared the methodology for group review and consensus. A modified Delphi method was used until consensus (> 66% agreement) was reached for each practice recommendation. Previous position statement recommendations were reviewed and voted to either retain, revise, or retire. Recommendations were categorized by level of ICU service to be applicable by setting and grouped into five domains: patient care, quality improvement, research and scholarship, training and education, and professional development. MAIN RESULTS There are 82 recommendation statements: 44 original recommendations and 38 new recommendation statements. Thirty-four recommendations represent the domain of patient care, primarily relating to critical care pharmacist duties and pharmacy services. In the quality improvement domain, 21 recommendations address the role of the critical care pharmacist in patient and medication safety, clinical quality programs, and analytics. Nine recommendations were made in the domain of research and scholarship. Ten recommendations were made in the domain of training and education and eight recommendations regarding professional development. CONCLUSIONS Critical care pharmacists are essential members of the multiprofessional critical care team. The statements recommended by this taskforce delineate the activities of a critical care pharmacist and the scope of pharmacy services within the ICU. Effort should be made from all stakeholders to implement the recommendations provided, with continuous effort toward improving the delivery of care for critically ill patients.
Collapse
|
6
|
Standardized approach of albumin, midodrine and octreotide on hepatorenal syndrome treatment response rate. Eur J Gastroenterol Hepatol 2021; 33:102-106. [PMID: 32243349 DOI: 10.1097/meg.0000000000001700] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hepatorenal syndrome (HRS) remains a serious complication of cirrhosis with a high mortality rate. There is little information on the effect of standardizing albumin, midodrine and octreotide combination on treatment response in patients with HRS. OBJECTIVE The aim of the study was to determine the impact of a standardized HRS treatment regimen on renal function recovery. The primary outcome was full response rate. Secondary outcomes included partial and no response rates, 30-day all-cause mortality, ICU length of stay (LOS), hospital LOS, liver transplantation and total dose of albumin. METHODS This retrospective study evaluated the impact of using a standardized approach with albumin, midodrine and octreotide on treatment response rates compared to a historical group. RESULTS Of the patients with HRS, 28 received a standardized approach with albumin, midodrine and octreotide while 60 received a nonstandardized approach. Ten percent of patients achieved full response in the prestandardization group compared with 25% in the poststandardization group (P = 0.07). Renal replacement therapy was significantly more prevalent in the prestandardization group vs. poststandardization group (45% vs. 21.4%, P = 0.03). Liver transplantation was performed significantly more often in the prestandardization group compared the poststandardization group (23% vs. 3.6%, P = 0.02). Amount of albumin used was statistically lower in the poststandardization group (425 vs. 332 g, P = 0.05). No significant differences in days of HRS treatment, mortality rate, hospital and ICU LOS were observed. CONCLUSION A trend towards improved treatment response rate was observed after standardizing the HRS treatment regimen. Standardized therapy led to significantly lower rates of renal replacement therapy and liver transplantation, suggesting patients in poststandardization were effectively managed medically without requiring further intervention.
Collapse
|
7
|
Tadrous M, Martins D, Mamdani MM, Gomes T. Characteristics of high-drug-cost beneficiaries of public drug plans in 9 Canadian provinces: a cross-sectional analysis. CMAJ Open 2020; 8:E297-E303. [PMID: 32345708 PMCID: PMC7207026 DOI: 10.9778/cmajo.20190231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Drugs are the fastest growing cost in the Canadian health care system, owing to the increasing number of high-cost drugs. The objective of this study was to examine the characteristics of high-drug-cost beneficiaries of public drug plans across Canada relative to other beneficiaries. METHODS We conducted a cross-sectional study among public drug plan beneficiaries residing in all provinces except Quebec. We used the Canadian Institute for Health Information's National Prescription Drug Utilization Information System to identify all drugs dispensed to beneficiaries of public drug programs in 2016/17. We stratified the cohort into 2 groups: high-drug-cost beneficiaries (top 5% of beneficiaries based on annual costs) and other beneficiaries (remaining 95%). For each group, we reported total drug costs, prevalence of high-cost claims (> $1000), median number of drugs, proportion of beneficiaries aged 65 or more, the 10 most costly reimbursed medications and the 10 medications most commonly reimbursed. We reported estimates overall and by province. RESULTS High-drug-cost beneficiaries accounted for nearly half (46.5%) of annual spending, with an average annual spend of $14 610 per beneficiary, compared to $1570 among other beneficiaries. The median number of drugs dispensed was higher among high-drug-cost beneficiaries than among other beneficiaries (13 [interquartile range (IQR) 7-19] v. 8 [IQR 4-13]), and a much larger proportion of high-drug-cost beneficiaries than other beneficiaries received at least 1 high-cost claim (40.9% v. 0.6%). Long-term medications were the most commonly used medications for both groups, whereas biologics and antivirals were the most costly medications for high-drug-cost beneficiaries. INTERPRETATION High-drug-cost beneficiaries were characterized by the use of expensive medications and polypharmacy relative to other beneficiaries. Interventions and policies to help reduce spending need to consider both of these factors.
Collapse
Affiliation(s)
- Mina Tadrous
- Women's College Hospital Research Institute (Tadrous); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Li Ka Shing Knowledge Institute (Martins, Gomes) and Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Mamdani, Gomes), University of Toronto; Department of Medicine (Mamdani), Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Diana Martins
- Women's College Hospital Research Institute (Tadrous); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Li Ka Shing Knowledge Institute (Martins, Gomes) and Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Mamdani, Gomes), University of Toronto; Department of Medicine (Mamdani), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Muhammad M Mamdani
- Women's College Hospital Research Institute (Tadrous); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Li Ka Shing Knowledge Institute (Martins, Gomes) and Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Mamdani, Gomes), University of Toronto; Department of Medicine (Mamdani), Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Tara Gomes
- Women's College Hospital Research Institute (Tadrous); Leslie Dan Faculty of Pharmacy (Tadrous, Mamdani, Gomes), University of Toronto; Li Ka Shing Knowledge Institute (Martins, Gomes) and Li Ka Shing Centre for Healthcare Analytics Research and Training (Mamdani), St. Michael's Hospital; Institute of Health Policy, Management and Evaluation (Mamdani, Gomes), University of Toronto; Department of Medicine (Mamdani), Faculty of Medicine, University of Toronto, Toronto, Ont
| |
Collapse
|
8
|
Ahearn J, Panda M, Carlisle H, Chaudhari T. Impact of inhaled nitric oxide stewardship programme in a neonatal intensive care unit. J Paediatr Child Health 2020; 56:265-271. [PMID: 31368171 DOI: 10.1111/jpc.14580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 07/06/2019] [Accepted: 07/16/2019] [Indexed: 12/26/2022]
Abstract
AIM Inhaled nitric oxide (iNO) is the most common, although expensive, therapy for persistent pulmonary hypertension of the newborn and hypoxaemic respiratory failure. With significant variation in iNO delivery practices amongst clinicians, this study aimed to assess the effectiveness of a stewardship programme in increasing clinician compliance with revised, standardised protocols and to measure the impact of compliance on iNO therapy use. METHODS Initiation and weaning protocols for iNO were introduced to the neonatal intensive care unit at The Centenary Hospital on 01 March 2016. A 2-year stewardship programme was utilised to assess protocol compliance and the resulting iNO usage impacts were measured. A combined retrospective and prospective study from 1 March 2014 to 28 February 2018 was conducted to compare the patterns of iNO utilisation between the pre- and post-stewardship cohorts. RESULTS The pre-stewardship cohort incorporated 18 neonates, receiving 19 iNO treatment episodes, and 18 neonates, receiving 21 iNO treatment episodes, in the post-stewardship cohort. No significant difference in patient demographics was determined. Compliance with the protocols improved from 61% in year 1 to 88% in year 2 of the stewardship programme. Significant reductions were observed in median total hours of iNO therapy per patient (P = 0.0014) and in median time from therapy initiation to initial wean (P < 0.0001). The cost of iNO therapy reduced 52% during the stewardship programme with no increase in adverse patient outcomes. CONCLUSION An iNO stewardship programme could be safely implemented in any NICU leading to increased protocol compliance with a beneficial reduction in iNO usage and cost.
Collapse
Affiliation(s)
- Joshua Ahearn
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Malavika Panda
- Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australian Capital Territory, Australia
| | - Hazel Carlisle
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australian Capital Territory, Australia
| | - Tejasvi Chaudhari
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Department of Neonatology, Centenary Hospital for Women and Children, Canberra Hospital, Woden, Australian Capital Territory, Australia
| |
Collapse
|
9
|
Altawalbeh SM, Abu-Su'Ud R, Alefan Q, Momany SM, Kane-Gill SL. Evaluating intensive care unit medication charges in a teaching hospital in Jordan. Expert Rev Pharmacoecon Outcomes Res 2019; 19:561-567. [PMID: 30663452 DOI: 10.1080/14737167.2019.1571413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Intensive Care Unit (ICU) medication costs contribute to a large portion of the total ICU costs. Evaluating ICU drug expenditures is essential for optimal resource use especially in countries with limited resources. Considering the dearth of data regarding ICU medication expenses in the Middle East, we sought to evaluate ICU medication charges at a large academic hospital in Jordan. Methods: ICU drug charges were extracted from the hospital administration database at King Abdullah University Hospital for 2014-2015 fiscal years (FYs). ICU drug charges were compared to non-ICU drug charges that were incurred during the same patient admissions. ICU medications with the most significant charges were identified. The most frequent diagnoses with the highest ICU medication charges were described. Results: Average ICU medication charges per day were approximately twice that of non-ICU medication charges ($121.5 versus $55.7 in 2014 and $100.2 versus $52.2 in 2015; p < 0.001 in both FYs). Meropenem and human albumin were the most expensive ICU medications. Drug charge allocation was most expensive for sepsis, motor vehicle accidents and respiratory failure. Conclusion: Drug charges in the ICU are considerably higher than non-ICU drug charges, thus requiring more vigilant cost containment approaches. Further research is needed to evaluate the appropriateness of expensive ICU medications.
Collapse
Affiliation(s)
- Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Rawan Abu-Su'Ud
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Qais Alefan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology , Irbid , Jordan
| | - Suleiman Mohammad Momany
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology , Irbid , Jordan
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh , Pittsburgh , PA , USA
| |
Collapse
|
10
|
Cobb A, Thornton L. Hyperinflation of Nitroprusside. J Pharm Pract 2018; 31:382-389. [PMID: 30071785 DOI: 10.1177/0897190018762182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sodium nitroprusside (SNP) is a generically available and rapid-acting intravenous (IV) vasodilator that has been used clinically for decades. Prior to 2013, the cost of SNP was relatively low, and SNP was an affordable option for the treatment of acute hypertension. However, from 2013 to 2017, average wholesale prices for SNP rose to as high as $900 per vial, earning the drug its status as a "hyperinflation drug." Hyperinflation drugs such as SNP pose a significant challenge for pharmacy departments. A multidisciplinary effort involving stakeholders from many backgrounds, including pharmacists, physicians, and nurses, is key to developing an effective plan to address the problem. A therapeutic interchange, wherein a drug with similar efficacy is substituted for another, is often an appropriate strategy in this scenario. Fortunately, alternative drugs with a solid evidence base exist for the management of acute hypertension. The dihydropyridine calcium channel blockers, clevidipine and nicardipine, are IV titratable antihypertensive agents with favorable pharmacokinetic and safety profiles. Various studies indicate that clevidipine and nicardipine are effective alternatives to SNP for indications including hypertensive crisis and postoperative hypertension. Some hospitals have reported significant cost savings without adverse outcomes by substituting clevidipine or nicardipine for SNP. This article is intended to serve as a review of the evidence for clevidipine and nicardipine as potential substitutes for SNP and to provide strategies to successfully implement this therapeutic interchange.
Collapse
Affiliation(s)
- Alex Cobb
- 1 St. John Medical Center, Tulsa, OK, USA
| | | |
Collapse
|
11
|
Abstract
Hundreds of oral and injectable generic drugs have seen dramatic price increases during the 2010s. Several reasons for the astronomic price increases have been postulated, ranging from reduced competition, shortages in the manufacturing supply chain, very small markets, market consolidation, the Unapproved Drugs Initiative of 2006, and unanticipated manufacturing safety issues. In one survey, over 90% of hospital administrators reported that higher drug prices had a moderate or severe impact on their budgets. Whereas compounding pharmacies may present an effective solution to high drug prices, it is a potentially dangerous one, as the case of New England Compounding Center makes clear. The risks make a meticulous vetting process necessary.
Collapse
Affiliation(s)
- Manny Saltiel
- Comprehensive Pharmacy Services, Costa Mesa, CA, USA
| | | |
Collapse
|
12
|
Palacios Rosas E, Soria-Cedillo IF, Puértolas-Balint F, Ibarra-Pérez R, Zamora-Gómez SE, Lozano-Cruz E, Amezcua-Gutiérrez MA, Castro-Pastrana LI. Impact of Implementing Smart Infusion Pumps in an Intensive Care Unit in Mexico: A Pre-Post Cost Analysis Based on Intravenous Solutions Consumption. Hosp Pharm 2018; 54:203-208. [PMID: 31205333 DOI: 10.1177/0018578718786943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The use of smart pump technology has shown to be profitable in the intensive care unit (ICU) because it avoids costs from prevented medication errors and allows for savings on disposables and medications by establishing standardized concentrations and dosing units. Objective: The objective of the study is to evaluate the economic impact of the implementation of smart infusion pumps in the consumption of intravenous (IV) solutions in an ICU. Methods: A retrospective observational study was conducted with a pre-post design. The study occurred in the adult ICU of the Hospital Juárez de México. The pattern of consumption of IV solutions (sodium chloride 9%, Hartmann's solution, dextrose 5% and 10%, sodium chloride 0.9% with dextrose 5%) was analyzed preimplementation and postimplementation of 50 Plum A+™ pumps with Hospira MedNet™ security software. Using the TreeAge Pro 2016 software, deterministic and probabilistic analyses were carried out (10 000 Monte Carlo simulations) to confirm the robustness of the annual consumption comparison and the associated expenses before and after implementing smart technology. Results: The implementation of the smart pumps reduced the annual consumption of IV solutions to 8994 units (18%) and 3649 liters (22.3%). In the first year, MXN$55 850.97 were saved. From an institutional perspective and with a probability of 0.63, the use of MedNet™ technology proved to be a lower cost alternative (17.1% saved) with respect to the conventional infusion systems. Conclusion: The implementation of smart infusion pumps allows savings, specifically for the IV solutions used in ICU.
Collapse
|
13
|
Cobb A, Thornton L. Sodium Nitroprusside as a Hyperinflation Drug and Therapeutic Alternatives. J Pharm Pract 2018; 31:374-381. [PMID: 29938566 DOI: 10.1177/0897190018776396] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sodium nitroprusside (SNP) is a generically available and rapid-acting intravenous (IV) vasodilator that has been used clinically for decades. Prior to 2013, the cost of SNP was relatively low, and SNP was an affordable option for the treatment of acute hypertension. However, from 2013 to 2017, average wholesale prices for SNP rose to as high as US$900 per vial, earning the drug its status as a "hyperinflation drug." Hyperinflation drugs pose a significant challenge for pharmacy departments. A multidisciplinary effort involving stakeholders from many backgrounds, including pharmacists, physicians, and nurses, is key to developing an effective cost containment strategy. A therapeutic interchange, wherein a drug with similar efficacy is substituted for another, is often an appropriate strategy to address rising drug costs. Fortunately, alternative drugs with a solid evidence base exist for the management of acute hypertension. The dihydropyridine calcium channel blockers, clevidipine and nicardipine, are IV titratable antihypertensive agents with favorable pharmacokinetic and safety profiles. Various studies indicate that clevidipine and nicardipine are effective alternatives to SNP for indications including hypertensive crisis and postoperative hypertension. Some hospitals have reported significant cost savings without adverse outcomes by substituting clevidipine or nicardipine for SNP. This article is intended to serve as a review of the evidence for clevidipine and nicardipine as potential substitutes for SNP and to provide strategies to successfully implement this therapeutic interchange.
Collapse
Affiliation(s)
- Alex Cobb
- 1 St John Medical Center, Tulsa, OK, USA
| | | |
Collapse
|
14
|
Abstract
Hundreds of oral and injectable generic drugs have seen dramatic price increases during the 2010s. Several reasons for the astronomic price increases have been postulated, ranging from reduced competition, shortages in the manufacturing supply chain, very small markets, market consolidation, the Unapproved Drugs Initiative of 2006, and unanticipated manufacturing safety issues. In one survey, over 90% of hospital administrators reported that higher drug prices had a moderate or severe impact on their budgets. Whereas compounding pharmacies may present an effective solution to high drug prices, it is a potentially dangerous one, as the case of New England Compounding Center makes clear. The risks make a meticulous vetting process necessary.
Collapse
Affiliation(s)
- Manny Saltiel
- Comprehensive Pharmacy Services, Costa Mesa, CA, USA
| | | |
Collapse
|
15
|
Schumock GT, Vermeulen LC. The Rising Cost of Prescription Drugs: Causes and Solutions. Pharmacotherapy 2016; 37:9-11. [DOI: 10.1002/phar.1873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Glen T. Schumock
- Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Lee C. Vermeulen
- University of Kentucky; Center for Health Services Research; College of Medicine; Lexington Kentucky
| |
Collapse
|