ArticleP & T : a peer-reviewed journal for formulary management2006
Formulary Substitution of Proton Pump Inhibitors Based on Acquisition Price: Changes in Usage and Costs of Acid-Suppressant Therapies.
Article in P & T : a peer-reviewed journal for formulary management, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
objectiveIn addition to indications for proton pump inhibitors (PPIs) outside the intensive-care unit (ICU), these medications are frequently used to manage nonvariceal upper gastrointestinal (GI) hemorrhage and to prevent stress-related mucosal bleeding in ICU patients. In September 2004, the P&T committee at the University of Colorado Health Sciences Center substituted three PPIs for one less expensive, preferred PPI product; all dosage forms were included. Our goal was to determine whether switching these PPIs to the least expensive agent would alter their usage and associated costs in the ICU (48 beds) and in non-ICU sites (325 beds).
methodsWe conducted analyses of hospital databases before the formulary switch of January 1, 2004, to June 30, 2004, and after the formulary switch of January 1, 2005, to June 30, 2005, to compare the usage and associated drug costs of PPIs and histamine-2 receptor antagonists (H
resultsCase-mix indices and length of stay data were similar before and after the switch. The total number of intravenous (IV) and enteral PPI doses charged before and after the switch increased from 1,544 to 4,143 units and from 11,865 units to 17,201 units, respectively. When we adjusted for patient-days, usage patterns of PPIs in non-ICU sites were similar before and after the switch (0.253 and 0.220 units per patient-day, respectively). In contrast, the use of PPIs in the ICU increased after the formulary switch (from 0.942 to 2.056 units per patient-day) as a result of the increased use of both IV PPIs (0.571 to 1.205 units per patient-day) and enteral PPIs (0.371 to 0.852 units per patient-day). Compared with non-ICU usage, the likelihood of PPI use in the ICU was 2.51 times higher after the switch (95% confidence interval [CI], 2.05-3.07;
conclusionSubstituting a less expensive PPI did not alter usage outside the ICU, but it was associated with increased usage in the ICU. Conversely, the use of IV H
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34522075PMC8437391W3200139487What OpenQuestion holds
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