6 INTERNATIONAL RESEARCH & OPINION Therapeutic substitution and dosage individualisation reduce costs Implementation of a therapeutic interchange and an individualised dosage programme at a US medical centre generated cost savings of SUS287 000 from July 1994 to March 1995. Parallel programmes A therapeutic interchange programme was developed through the centre's Antibiotic Subcommittee for the third-generation cephalosporins ceftizoxime, ceftriaxone and cefotaxime. After reviewing the literature, the committee recommended that: • ceftizoxime should be the preferred third-generation cephalosporin for inpatients • ceftriaxone use should be restricted to paediatric patients and those with empiric and/or documented central nervous system infections • cefotaxime should be deleted from the hospital formulary. These recommendations were accepted, and an automatic substitution policy was introduced. At the same time, a computer programme was used to identify all patients at the hospital with renal insufficiency. Data showed that patients receiving agents that were primarily renally-eliminated tended to receive unadjusted dosages. The agents that were targeted as part of the Individualized Dosing Subcommittee's programme were primarily renally-eliminated antibacterials, Hrantagonists, metoclopramide, metformin, digoxin and allopurinol. Decrease in ceftriaxone use Total use of ceftriaxone decreased by 2055g at the centre in the first 6 months of 1995, compared with the same period in 1994, with use of the 1 and 2g vials decreasing by 1360 and nOg, respectively, and use of the paediatric 500mg form remaining constant. In contrast, the pharmacy department purchased 60 199 of ceftizoxime during the first 6 months of 1995. ACluisition cost of third-generation cep alosporins at the centre I DNa J8rNun IBM (SUS\ J8n.Jun 1e85 lSUS\ ceftIzolClme NA 32024 Cefolaxi'ne 22000 NA Ceftriaxone 80980 38940 NA = not avaIable Notably, the total acquisition cost of ceftizoxime and ceftriaxone for the first 6 months of 1995 was about $US32 000 lower than that for the same period in 1994 ($US70 964 vs SUS 102980, respectively) [see table]. In particular, the decision to introduce ceftizoxime on the formulary as the third-generation cephalosporin of choice generated cost savings of SUS 130 000 in the first 8 months of 1995. No increase in use of other agents Importantly, the reduction in overall use of the third-generation cephalosporins was not offset by an increased use of other broad-spectrum agents, the PharmacoEconomics & Outcomes News 5 OCt 1996 No. 82 study authors point out. Total acquisition costs for imipenem and IV ciprofloxacin decreased by $US26 000 and $US9000, respectively, during the first half of 1995, while the cost for tazobactam + piperacillin remained constant. Furthermore, the average daily antibacterial cost/patient decreased from 5US12.80 in the first 6 months of 1994 to $U59.9O over the same period in 1995. The individualised dosing programme alone resulted in cost savings of $US80 000 in the first 6 months of 1995. Dutcher R. Implementing a therapeutic interchange and individualized dosing program: using the staff pharmacist. P & T 21: 435-438 & 44I-442 & 444-445. Aug 1996 _'00 1173-550319610082-00061$01,00°Adl.lnternatlonel Limited 1996. All right. reaerved

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6INTERNATIONAL RESEARCH & OPINION

Therapeutic substitution and dosageindividualisation reduce costs

Implementation of a therapeutic interchange and anindividualised dosage programme at a US medicalcentre generated cost savings of SUS287 000 fromJuly 1994 to March 1995.

Parallel programmesA therapeutic interchange programme was developed

through the centre's Antibiotic Subcommittee for thethird-generation cephalosporins ceftizoxime, ceftriaxoneand cefotaxime. After reviewing the literature, thecommittee recommended that:• ceftizoxime should be the preferred third-generation

cephalosporin for inpatients

• ceftriaxone use should be restricted to paediatricpatients and those with empiric and/or documentedcentral nervous system infections

• cefotaxime should be deleted from the hospitalformulary.

These recommendations were accepted, and anautomatic substitution policy was introduced.

At the same time, a computer programme was usedto identify all patients at the hospital with renalinsufficiency. Data showed that patients receiving agentsthat were primarily renally-eliminated tended to receiveunadjusted dosages. The agents that were targeted aspart of the Individualized Dosing Subcommittee'sprogramme were primarily renally-eliminatedantibacterials, Hrantagonists, metoclopramide,metformin, digoxin and allopurinol.

Decrease in ceftriaxone useTotal use of ceftriaxone decreased by 2055g at the

centre in the first 6 months of 1995, compared withthe same period in 1994, with use of the 1 and 2g vialsdecreasing by 1360 and nOg, respectively, and use ofthe paediatric 500mg form remaining constant. Incontrast, the pharmacy department purchased 60199of ceftizoxime during the first 6 months of 1995.

ACluisition cost of third-generationcep alosporins at the centreIDNa J8rNun IBM (SUS\ J8n.Jun 1e85 lSUS\

ceftIzolClme NA 32024Cefolaxi'ne 22000 NA

Ceftriaxone 80980 38940

NA=not avaIable

Notably, the total acquisition cost of ceftizoximeand ceftriaxone for the first 6 months of 1995 wasabout $US32 000 lower than that for the same periodin 1994 ($US70 964 vs SUS 102980, respectively)[see table]. In particular, the decision to introduceceftizoxime on the formulary as the third-generationcephalosporin of choice generated cost savings ofSUS 130 000 in the first 8 months of 1995.

No increase in use of other agentsImportantly, the reduction in overall use of the

third-generation cephalosporins was not offset by anincreased use of other broad-spectrum agents, the

PharmacoEconomics & Outcomes News 5 OCt 1996 No. 82

study authors point out. Total acquisition costs forimipenem and IV ciprofloxacin decreased by$US26 000 and $US9000, respectively, during thefirst half of 1995, while the cost for tazobactam +piperacillin remained constant. Furthermore, the averagedaily antibacterial cost/patient decreased from 5US12.80in the first 6 months of 1994 to $U59.9O over the sameperiod in 1995.

The individualised dosing programme alone resultedin cost savings of $US80 000 in the first 6 months of1995.

Dutcher R. Implementing a therapeutic interchange and individualizeddosing program: using the staff pharmacist. P & T 21: 435-438 & 44 I-442& 444-445. Aug 1996 _'00

1173-550319610082-00061$01,00°Adl.lnternatlonel Limited 1996. All right. reaerved