Does accepting pharmacokinetic recommendations impact hospitalization? A cost-benefit analysis

Abstract

In a prospective, randomized study, 110 adults receiving aminoglycosides were randomized to follow-up by a clinical pharmacokinetic service (CPS). Of the 110 patients, 35 accepted pharmacokinetic recommendations less than 100% of the time. The two groups were similar in age, sex, height, APACHE II score, and initial creatinine clearance. A cost-to-charge ratio was used to derive direct costs of hospitalization and calculate cost-benefit. Patients whose physicians accepted pharmacokinetic recommendations 100% of the time had shorter hospitalizations (322.67 +/- 270.28 h; CPS less than 100%, 699.54 +/- 806.35; p = 0.001) and febrile periods (50.05 +/- 79.38 h; CPS less than 100%, 120.00 +/- 153.23; p = 0.002). Acceptance of CPS recommendations led to adequate peak levels. Acceptance of CPS recommendations led to lower direct costs ($7,102.56 +/- 9,898.19; CPS less than 100%, $19,629.94 +/- 28,051.89; p less than 0.001). Calculated direct cost of the service was $85/patient.