Impact of a change of bronchodilator medications in a hospital drug formulary on intra- and out-of-hospital drug prescriptions: interrupted time series design with comparison group

Raquel Vázquez-Mourelle,Adolfo Figueiras,Eduardo Carracedo-Martínez

doi:10.1186/s13012-020-00996-y

Abstract

BackgroundHospital drug formularies are reduced lists of drugs designed to optimise inpatient care. Adherence to the drugs included in such formularies is not always 100% but is generally very high. Little research has targeted the impact of a change in these formularies on outpatient drug prescriptions. This study therefore sought to evaluate the impact of a change affecting bronchodilator medications in a hospital drug formulary on intra- and out-of-hospital drug prescriptions in a region in north-western Spain. Two new drugs belonging to this same class were brought onto the out-of-hospital market, overlapping with the intervention.MethodsWe used a natural before-after quasi-experimental design with control group based on monthly data. The intervention evaluated was the modification of a hospital drug formulary, which involved withdrawing salmeterol/fluticasone in order to retain formoterol/budesonide as the sole inhaled corticosteroid and long-acting beta-agonist (ICS/LABA). Using official data sources, we extracted the following dependent variables: defined daily doses (DDD) per 1000 inhabitants per day, DDD per 100 bed-days, and cost per DDD.ResultsIntra-hospital use showed a 173.2% rise (95% CI 47.3–299.0%) in the medication retained in the formulary, formoterol/budesonide, and a 94.9% drop (95% CI 77.9–111.9%) in the medication withdrawn from the formulary, salmeterol/fluticasone. This intervention led to an immediate reduction of 75.9% (95% CI 82.8–68.9%) in the intra-hospital cost per DDD of ICS/LABA. No significant changes were observed in out-of-hospital use.ConclusionsAlthough this intervention was cost-effective in the intra-hospital setting, the out-of-hospital impact of a change in the drug formulary cannot be generalised to all types of medications and situations.

Highlights

Pharmaceutical products account for a substantial proportion of total health-care expenditure in developed countries [1]
It appears that the impact induced by a change in hospital pharmacotherapy guidelines on intra- and out-of-hospital drug prescriptions cannot be generalised to all compounds and circumstances
Beyond the change in hospital pharmacotherapy guidelines, there are external factors, such as the recent appearance on the market of new medications in the same group, which could serve to neutralise the possible effect of a guideline change at an out-of-hospital level

Summary

Introduction

Pharmaceutical products account for a substantial proportion of total health-care expenditure in developed countries [1]. Recent studies conducted by our group found that a change in low molecular weight heparins (LMWH) in the HDF had an important impact (induction of prescription) on the out-of-hospital setting [17]. Even so, it is not known whether this effect is generalisable or, on the contrary, depends on other factors, such as therapeutic group, type of formulary change (withdrawal, restriction on use, or inclusion), or other contextual factors, e.g. the marketing of new drugs. Two new drugs belonging to this same class were brought onto the out-of-hospital market, overlapping with the intervention

Methods

Results

Discussion

Conclusion