Analysis of the economic burden of docusate sodium at a United States tertiary care center.

OBJECTIVES: The primary objective was to determine the financial resources allocated to docusate at a representative U.S. tertiary care center. Secondary objectives included comparing docusate utilization between two tertiary care centers, and exploring alternative uses for the funds spent on docusate. METHODS: The study population included all patients 18 years and older admitted to University Hospital in Newark, New Jersey. Every scheduled docusate prescription for the study population between January 1st, 2015 and December 31st, 2019 was collected. The annual total cost associated with docusate use per year was calculated. The 2015 data from this study and a 2015 McGill University Health Centre study were compared. Also, alternative uses for the money utilized on docusate were assessed. RESULTS: Over the study period, 37,034 docusate prescriptions and 265,123 docusate doses were recorded. The average cost of prescribing docusate was $25,624.14 per year and $49.37 per hospital bed per year. A comparison between the 2015 data of University Hospital and McGill showed that McGill prescribed 107 doses and spent $10.09 more per hospital bed than University Hospital. Finally, alternative uses for the average yearly spending on docusate equated to 0.35 the salary of a nurse, 0.51 the salary of a secretary, 20.66 colonoscopies, 27.00 upper endoscopies, 186.71 mammograms, 1,399.37 doses of polyethylene glycol 3350, 3,826.57 doses of lactulose, or 4,583.80 doses of psyllium. CONCLUSION: A single average size tertiary care hospital spent about $25,000 yearly on docusate despite its lack of clinical effectiveness. While this amount is small compared to an overall hospital budget, when considering likely comparable docusate use at the U.S's 6,090 hospitals, the economic burden of docusate becomes significant. The funds currently being used on docusate could be redirected to alternative, more cost-effective purposes.

Cutaneous leishmaniasis and rickettsial African tick-bite fever: a combination of exotic traveler's diseases in the same patient.

BACKGROUND: Cutaneous leishmaniasis and rickettsial African tick-bite fever are two zoonoses increasingly diagnosed in industrialized nations due to more international travel to endemic areas. METHODS: A 52-year-old American nurse was evaluated for a 0.5 cm well-demarcated, tender, shallow ulcer on her wrist, nonproductive cough, fever, chills, and night sweats, all of which began three weeks after travel to Botswana and a visit to a game reserve, where she reported being scratched on the ankle by a cheetah. RESULTS: This cutaneous finding was strongly suggestive of leishmaniasis, but the systemic symptoms were perplexing. Although excisional biopsy showed only nonspecific changes, a specimen sent to the United States Centers for Disease Control revealed leishmania promastigotes of L. tropica. Initial Rickettsia typhi titers and many other serologic tests were negative. However, four weeks after admission, R. typhi IgG titer was 1 : 64 and R. rickettsii IgG was 1 : 1024. CONCLUSION: Thus, our patient had two tropical diseases simultaneously.