Cost-benefit analysis of pharmacist interventions over 36 months in a university hospital

ABSTRACT OBJECTIVE: To perform a cost-benefits analysis of a clinical pharmacy (CP) service implemented in a Neurology ward of a tertiary teaching hospital. METHODS: This is a cost-benefit analysis of a single arm, prospective cohort study performed at the adult Neurology Unit over 36 months, which has evaluated the results of a CP service from a hospital and Public Health System (PHS) perspective. The interventions were classified into 14 categories and the costs identified as direct medical costs. The results were analyzed by the total and marginal cost, the benefit-cost ratio (BCR) and the net benefit (NB). RESULTS: The total 334 patients were followed-up and the highest occurrence in 506 interventions was drug introduction (29.0%). The marginal cost for the hospital and avoided cost for PHS was US$182±32 and US$25,536±4,923 per year; and US$0.55 and US$76.4 per patient/year. The BCR and NB were 0.0, -US$26,105 (95%CI −31,850 − -10,610), -US$27,112 (95%CI −33,160-11,720) for the hospital and; 3.0 (95%CI 1.97-4.94), US$51,048 (95%CI 27,645-75,716) and, 4.6 (95%CI 2.24-10.05), US$91,496 (95%CI 34,700-168,050; p < 0.001) for the PHS, both considering adhered and total interventions, respectively. CONCLUSIONS: The CP service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS.

Patient safety and the value of pharmaceutical intervention in a cancer hospital / Segurança do paciente e o valor da intervenção farmacêutica em um hospital oncológico

ABSTRACT Objective To demonstrate economic impact of pharmaceutical evaluation in detection and prevention of errors in antineoplastic prescriptions. Methods This was an observational and retrospective study performed in a cancer hospital. From July to August 2016 pharmacists checked prescriptions of antineoplastic and adjuvant drugs. Drug-related problems observed were classified and analyzed concerning drug, pharmaceutical intervention, acceptability and characteristic of the error. In case of problem related to dose, we calculated a deviation percentage related with correct dose and value spent or saved. Data were analyzed using descriptive statistics with frequency and percentage. Results A total of 6,104 prescriptions and 12,128 medications were evaluated. Drug-related problems were identified in 274 (4.5%) prescriptions. Most of them was due to lack of information (n=117; 36.1%). Problems associated with dose accounted for 32.1% (n=98) of the total. In 13 cases (13.3%) ranging of prescribed dose was 50% greater than the correct dose. Intercepted drug-related problems provided savings of R$54.081,01 and expenses of R$20.863,36, therefore resulting in a positive balance of R$33.217,65. Each intervention promoted saving of R$126,78 with an acceptance rate of 98%. Main pharmaceutical interventions were information inclusion (n=117; 36.1%) and dose change (n=97; 29.9%). All errors were classified as error with no harm. Conclusion Simple actions such as prescription checking are able to identify and prevent drug-related problems, avoid financial losses and add immeasurable value to patient safety.

RESUMO Objetivo Demonstrar o impacto econômico da avaliação farmacêutica na detecção e na prevenção de erros em prescrições de antineoplásicos. Métodos Estudo observacional e retrospectivo realizado em um hospital oncológico. De julho a agosto de 2016, prescrições contendo antineoplásicos e fármacos adjuvantes ao tratamento foram avaliadas por farmacêuticos. Os problemas detectados relacionados a medicamentos foram classificados e analisados quanto ao medicamento, à intervenção farmacêutica, à aceitabilidade e à caracterização do erro. Quando o problema envolveu dose, calcularam-se a percentagem de desvio em relação à dose correta e o valor gasto ou economizado. Os dados foram analisados por estatística descritiva com aplicação de frequência e percentual. Resultados Foram avaliadas 6.104 prescrições e 12.128 medicamentos. Identificaram-se problemas relacionados a medicamentos em 274 (4,5%) prescrições, sendo a maioria causado por falta de informações (n=117; 36,1%). Quando reunidos, os problemas envolvendo dose representaram 32,1% (n=98) do total. Em 13 casos (13,3%), a variação da dose prescrita em relação à correta foi maior do que 50%. Os problemas relacionados a medicamentos interceptados representaram economia de R$54.081,01 e gastos de R$20.863,36, resultando em saldo positivo de R$33.217,65. Cada intervenção promoveu economia de R$126,78 com aceitabilidade de 98%. As principais intervenções foram inclusão de informações (n=117; 36,1%) e alteração de dose (n=97; 29,9%). Todos os erros foram considerados sem dano. Conclusão Ações simples de serem implantadas, como análise de prescrições, são capazes de identificar e prevenir problemas relacionados a medicamentos, evitar perdas financeiras e agregar imensurável valor na segurança do paciente.

Impact assessment of an automated drug-dispensing system in a tertiary hospital

OBJECTIVE: To evaluate the costs and patient safety of a pilot implementation of an automated dispensing cabinet in a critical care unit of a private tertiary hospital in São Paulo/Brazil. METHODS: This study considered pre- (January-August 2013) and post- (October 2013-October 2014) intervention periods. We considered the time and cost of personnel, number of adverse events, audit adjustments to patient bills, and urgent requests and returns of medications to the central pharmacy. Costs were evaluated based on a 5-year analytical horizon and are reported in Brazilian Reals (R$) and US dollars (USD). RESULTS: The observed decrease in the mean number of events reported with regard to the automated drug-dispensing system between pre- and post-implementation periods was not significant. Importantly, the numbers are small, which limits the power of the mean comparative analysis between the two periods. A reduction in work time was observed among the nurses and administrative assistants, whereas pharmacist assistants showed an increased work load that resulted in an overall 6.5 hours of work saved/day and a reduction of R$ 33,598 (USD 14,444) during the first year. The initial investment (R$ 206,065; USD 88,592) would have been paid off in 5 years considering only personnel savings. Other findings included significant reductions of audit adjustments to patient hospital bills and urgent requests and returns of medications to the central pharmacy. CONCLUSIONS: Evidence of the positive impact of this technology on personnel time and costs and on other outcomes of interest is important for decision making by health managers.

Custos com antimicrobianos no tratamento de pacientes com infecção da corrente sanguínea em uma unidade de terapia intensiva / Cost of antimicrobial treatment in patients with blodstream infection in an intensive care unit

A infecção da corrente sanguínea (ICS) é uma das infecções relacionadas à assistência em saúde de maior relevância, devido a sua alta prevalência, morbimortalidade, aos custos associados e, principalmente, à possibilidade de prevenção. Dentre os principais microrganismos a elas associados, ressalta-se o Staphylococcus aureus, sobretudo aqueles resistentes. Os custos relacionados ao tratamento antimicrobiano de pacientes com ICS causada por microrganismos resistentes têm sido pouco explorados. Diante disto, objetivou-se comparar os custos com o tratamento antimicrobiano de pacientes com infecção da corrente sanguínea causada por Staphylococcus aureus resistentes com os custos decorrentes do tratamento envolvendo Staphylococcus aureus sensíveis. Trata-se de um estudo epidemiológico do tipo coorte histórica, realizado em uma Unidade de Terapia Intensiva de um hospital geral, de alta complexidade e privado de Belo Horizonte. A população do estudo foi composta por todos os pacientes que receberam o diagnóstico de ICS por Staphylococcus aureus, com base nos critérios estabelecidos pelo National Healthcare Safety Network do Centers for Disease Control and Prevention, no período de março de 2007 a março de 2011. Para a coleta dos dados, as informações sobre a ocorrência da ICS e o número de doses dos antimicrobianos utilizadas no tratamento foram obtidas por meio dos prontuários dos pacientes e dos registros da Comissão de Controle de Infecção Hospitalar. Aquelas referentes aos custos foram calculadas de acordo com o Guia Farmacêutico Brasíndice. Os dados foram analisados no programa de estatístico SPSS. Realizaram-se análise descritiva, univariada e regressão linear. Fizeram parte do estudo 62 pacientes, sendo 31 incluídos no grupo de pacientes com ICS causada por Staphylococcus aureus resistente à oxacilina e 31 incluídos no grupo com ICS por Staphylococcus aureus sensível à oxacilina. Dentre os fatores de risco para ocorrência de ICS por MRSA, a colonização...

Bloodstream infections (BSI) are one of the most relevant healthcare associated infections (HAI), because of its high prevalence, morbimortality, associated costs and, especially, the possibility of prevention. Between the main microorganisms associated with them, it is emphasized Staphylococcus aureus, especially those resistant. Costs related to the antimicrobial treatment of patients with BSI caused by resistant microorganisms are not well known. Thus, this study aimed to compare the costs with antimicrobial treatment of patients with BSI due to Staphylococcus aureus resistant and sensitive to oxacillin (MRSA and MSSA). It was an epidemiological study, conducted in an intensive care unit from a general, high complexity and private hospital from Belo Horizonte. The study population consisted of all patients who were diagnosed with BSI due to Staphylococcus aureus, according to the criteria established by the National Healthcare Safety Network from Centers for Disease Control and Prevention, during March 2007 and March 2011. For data collection, information about the occurrence of the BSI and the number of doses of antimicrobial used for the treatment were obtained from medical and infection control committee records. Those about costs of drugs were calculated according to the financial system. Data were analyzed using the statistical program SPSS. Descriptive, univariated and multivariated analysis were performed. 62 patients were included in the study, 31 in the group of patients with BSI caused by resistant Staphylococcus aureus and 31 in the group with sensitive Staphylococcus aureus. The most important risk factor for development of BSI due to MRSA were colonization with epidemiological important resistant microorganisms (p<0.05). It was observed that bacterial resistance was related to a higher mortality rate (p=0,025), as well as longer length of stay in the intensive care unit and in the institution (p=0,001). The most commom antibiotics...

Abasto, surtimiento y gasto de bolsillo en medicamentos en hospitales públicos de México en 2009 / Supply prescription filling and out-of-pocket expenditures on medicines in public hospitals in Mexico in 2009

OBJETIVO. Analizar la disponibilidad de medicamentos en las farmacias hospitalarias, el surtimiento de prescripciones a pacientes egresados y el gasto de bolsillo en medicamentos de pacientes hospitalizados. MATERIAL Y MÉTODOS. Análisis descriptivo de la Encuesta Nacional de Satisfacción y Trato Adecuado (ENSATA) de 2009 con una muestra representativa de hospitales públicos sobre disponibilidad de una lista de 83 medicamentos en el momento de la visita a la farmacia, la proporción del surtimiento de recetas a pacientes en el momento de su alta y su gasto de bolsillo durante su estancia hospitalaria. RESULTADOS. En total se entrevistó a 26 271 pacientes egresados de los 160 hospitales públicos visitados. La disponibilidad de medicamentos en el ámbito nacional fue de 82 por ciento. Los hospitales de los Servicios Estatales de Salud (SESA) mostraron una disponibilidad de 77 por ciento (variación de 30 a 96 por ciento). El surtimiento completo de recetas fue de 97 por ciento en las instituciones de seguridad social, cifra que contrasta con 56.2 por ciento de los hospitales de los SESA, que además presentaron una gran varianza entre estados (13 a 94 por ciento) La mediana del gasto de pacientes hospitalizados fue de 150 pesos moneda nacional (1 por ciento gastó más de 10 000 pesos. CONCLUSIONES. La falta de los medicamentos en los hospitales tiene un impacto económico en el gasto de los hogares, particularmente en aquellos que cuentan con pocos recursos, y puede aumentar la morbilidad o mortalidad de los pacientes hospitalizados en las instituciones públicas.

OBJECTIVE. To analyze the availability of drugs in public hospitals, the prescription-filling patterns for in-patients when they are discharged and their out-of-pocket expenditure during their hospitalization. MATERIAL AND METHODS. Using the National Satisfaction and Responsiveness Survey (ENSATA) 2009, which includes a representative sample of public hospitals in Mexico in 2009, the availability of 83 essential medicines in the hospital pharmacies at the day of visit, the proportion of prescriptions completely filled for patients when they are discharged and their out-of-pocket expenditure during their hospitalization were analyzed. RESULTS. A total of 26 271 patients in 160 public hospitals were interviewed. The mean availability of drugs was 82 percent for all hospitals, with the lowest availability for the Ministry of Health (SESA) hospitals (77 percent, with a range of 30 to 96 percent). Patients discharged at social security hospitals received in 97 percent of cases a complete prescription filling, while in SESA hospitals the average was only 56.2 percent, with a large variance among states (13 to 94 percent). The median inpatient spending was 150 pesos in national currency (1 percent spent over 10 000 pesos). CONCLUSIONS. The lack of medicines in public hospitals may increase in-patient morbidity and mortality and has an economic impact on household spending, particularly in those with scarce resources.

Cost of drugs manufactured by the University Hospital - role of the Central Pharmacy

The hospital pharmacy in large and advanced institutions has evolved from a simple storage and distribution unit into a highly specialized manipulation and dispensation center, responsible for the handling of hundreds of clinical requests, many of them unique and not obtainable from commercial companies. It was therefore quite natural that in many environments, a manufacturing service was gradually established, to cater to both conventional and extraordinary demands of the medical staff. That was the case of Hospital das Clinicas, where multiple categories of drugs are routinely produced inside the pharmacy. However, cost-containment imperatives dictate that such activities be reassessed in the light of their efficiency and essentiality. METHODS: In a prospective study, the output of the Manufacturing Service of the Central Pharmacy during a 12-month period was documented and classified into three types. Group I comprised drugs similar to commercially distributed products, Group II included exclusive formulations for routine consumption, and Group III dealt with special demands related to clinical investigations. RESULTS: Findings for the three categories indicated that these groups represented 34.4 percent, 45.3 percent, and 20.3 percent of total manufacture orders, respectively. Costs of production were assessed and compared with market prices for Group 1 preparations, indicating savings of 63.5 percent. When applied to the other groups, for which direct equivalent in market value did not exist, these results would suggest total yearly savings of over 5 100 000 US dollars. Even considering that these calculations leave out many components of cost, notably those concerning marketing and distribution, it might still be concluded that at least part of the savings achieved were real. CONCLUSIONS: The observed savings, allied with the convenience and reliability with which the Central Pharmacy performed its obligations, support the contention that internal manufacture of pharmaceutical formulations was a cost-effective alternative in the described setting

Effect of antibiotic order form guiding rational use of expensive drugs on cost containment.

New injectable antimicrobial agents are generally costly and broad-spectrum. Overusage results in unnecessary economic loss and multi-drug resistant organisms. Effective strategies for decreasing costs without compromising patient care are required. This study aimed to evaluate the economic impact of a system using an antimicrobial order form to assist rational usage of expensive antimicrobial agents. The study was performed during 1988-1996 at a 900-bed, tertiary-care, medical school hospital in Bangkok. The target drugs were 3 costly, broad-spectrum antibacterial drugs, namely imipenem, vancomycin, and injectable ciprofloxacin. The restriction of these 3 drugs was started in 1992 and was extended to netilmicin and ceftazidime in 1995. A filled antimicrobial order form (AOF) was required by pharmacists before dispensing the drugs. The AOF guided the physicians to give explicit information about anatomic diagnosis, etiologic diagnosis, and suspected antimicrobial resistance patterns of the organisms. It also contained information about indications of the restricted drugs. The filled forms were audited daily during working days by the chairman of The Hospital Antibiotic Committee. Feedback was given to the prescribers by infectious disease specialists at least twice a week. The strategy was endorsed by the executive committee of the hospital. Impact of AOF without endorsement, audit and feedback, was evaluated in 1996. The expenditures of the drugs were adjusted to the average admitted patient-days per fiscal year of the study period. The system with endorsement was well accepted and could be maintained for 4 years. The adjusted expenditures per year of the 3 restricted antibiotics were 1.41-1.87 million baht less (22-29%) in 1992-1994 than the pre-intervention year 1991. The cost reduction of imipenem and injectable ciprofloxacin could also be maintained for 1995 but not vancomycin for which use increased. The costs of these 3 restricted drugs increased very sharply (69%) in 1996 when there was loss of endorsement and capacity to perform auditing and feed back by infectious disease specialists. The system did not work with ceftazidime which was commonly used for febrile neutropenia and nosocomial infections.