A multidisciplinary hospital-based antimicrobial use program: Impact on hospital pharmacy expenditures and drug use

Abstract

The authors' hospital embarked on a three-component, multidisciplinary, hospital-based antimicrobial use program to cut costs and reduce inappropriate antimicrobial use. Initially, antimicrobial use patterns and costs were monitored for 12 months. For the next two years, an antimicrobial use program was implemented consisting of three strategies: automatic therapeutic interchanges; antimicrobial restriction policies; and parenteral to oral conversion. The program resulted in a reduction in the antimicrobial portion of the total pharmacy drug budget from 41.6% to 28.2%. Simultaneously, the average cost per dose per patient day dropped from $11.88 in 1991 to $10.16 in 1994. Overall, mean monthly acquisition cost savings rose from $6,810 in 1992 to $27,590 in 1994. This study demonstrates that a multidisciplinary antimicrobial use program in a Canadian hospital can effect dramatic cost savings and serve as a quality assurance activity of physician antimicrobial prescribing behaviour.

Keywords: Antibiotic use program; Hospital expenditure.

Figure 1

Sample of therapeutic interchange form

Figure 2

Sample of intravenous to oral reminder sticker

Figure 3

Antimicrobial expenditures as a percentage of the total drug acquisition costs from 1981 to 1994. Bars represent total drug costs; the line indicates antimicrobial costs

Figure 4

Average monthly antibiotic purchasing costs in the years 1991 to 1994

Figure 5

Monthly use patterns of intravenous (I.V.) vancomycin and ceftazidime before and after intervention in August 1992