Cost Reduction of Inhaled Tobramycin by Use of Preservative-Free Intravenous Tobramycin Given via Inhalation.

Timothy Gauthier,Margaret Fernandez,Lilian Abbo,Nathan Unger,Justin Wasko,Laura Aragon

doi:10.3390/antibiotics5010002

Abstract

This study evaluates drug cost outcomes related to automatic therapeutic substitution of branded tobramycin solution for inhalation (TOBI®) with inhaled generic preservative-free intravenous tobramycin (PFIT). A retrospective single-center evaluation of inhaled tobramycin use from 2008 through 2012 was performed. Number of doses dispensed and acquisition costs were obtained. Hourly wage data was acquired, pharmacy production costs were estimated and total cost-savings calculated. Days of therapy (DOTs) were determined for each year. Quality assurance and safety data was collected. In 2008, TOBI® drug costs and doses dispensed were $118,665 and 1769, respectively. Following implementation of the interchange in May 2009, TOBI® utilization ceased. PFIT costs in 2010 through 2012 averaged $34,775 annually and TOBI® cost-avoidance exceeded $94,000 annually when accounting for pharmacy production costs, which were determined to be at most $5.28 per dose. The maximum estimated pharmacy production cost ranged from $8812 to $11,299 annually. PFIT doses dispensed exceeded 1650 each year and annual DOTs ranged from 815 to 1069. The 40-month savings were calculated to be $374,706. Quality assurance and safety data identified one patient who refused PFIT due to odor complaints and one patient who was inappropriately administered a dose orally. Therapeutic substitution of TOBI® with PFIT can produce immediate and sustained savings with an acceptable safety profile.

Highlights

Antimicrobial stewardship programs (ASPs) are interdisciplinary bodies that continuously strive to optimize patient care related to the use of antimicrobial agents [1]
The literature infrequently describes outcomes related to automatic therapeutic substitution as an ASP strategy, yet these interventions may offer obtainable targets and require minimal resource investment
December 2012, tobramycin were were dispensed to a total of patients and annual doses exceeded for all years (Figure dispensed to a total of 486 patients and annual doses exceeded 1650 for all years (Figure 1). 1)

Summary

Introduction

Antimicrobial stewardship programs (ASPs) are interdisciplinary bodies that continuously strive to optimize patient care related to the use of antimicrobial agents [1]. Automatic therapeutic substitution is one method utilized to reduce healthcare costs while sustaining patient quality of care. Antibiotics 2016, 5, 2 these policies, when a prescriber orders a high cost medication, an institutional protocol is in place directing the pharmacy to dispense a less expensive therapeutic equivalent. Such interventions can require minimal resources, produce significant cost-reductions and are typically approved by hospital policy makers (e.g., an inter-disciplinary Pharmacy and Therapeutics Committee). The literature infrequently describes outcomes related to automatic therapeutic substitution as an ASP strategy, yet these interventions may offer obtainable targets and require minimal resource investment. Replacing oral Vancocin® with generic intravenous (IV) vancomycin prepared for oral administration has been previously reported to produce over $218,000 in annual cost-avoidance at a large medical center [2]

Methods

Results

Discussion

Conclusion