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. 2025 Mar;23(2):183-195.
doi: 10.1007/s40258-024-00937-6. Epub 2024 Dec 19.

Cost-Effective and Sustainable Drug Use in Hospitals: A Systematic and Practice-Based Approach

Michiel Zietse #  1 , Shannon L van der Zeeuw #  2 , Anne-Sophie Klein Gebbink  2 , Annemarie C de Vries  3 , Marie-Rose B S Crombag  2 , Roelof W F van Leeuwen  2   4 , Maaike J Hoedemakers  5
Affiliations

Cost-Effective and Sustainable Drug Use in Hospitals: A Systematic and Practice-Based Approach

Michiel Zietse et al. Appl Health Econ Health Policy. 2025 Mar.

Abstract

Background and objective: Rising healthcare costs challenge the financial sustainability of healthcare systems. Interventional pharmacoeconomics has emerged as a vital discipline to improve the cost-effective and sustainable use of drugs in clinical practice. However, current efforts are often fragmented, highlighting the need for an integrated hospital-wide approach. This study aimed to develop a scalable framework to systematically identify and implement cost-effective and sustainable drug use practices in hospitals.

Methods: This study was conducted at the Erasmus University Medical Centre in Rotterdam between December 2022 and July 2023. A novel '8-Step Efficiency Model' was designed to systematically identify and evaluate strategies for cost-effective and sustainable drug use. The process involved identifying high-expenditure drugs, systematically assessing these drugs using the Efficiency Model, and conducting a multi-disciplinary evaluation of the proposed cost-effectiveness strategies.

Results: The study assessed 39 high-cost drugs, representing 57% of the Dutch national expensive drug expenditure in 2021. Initiatives for enhancing cost-effectiveness and sustainability were identified or developed for 27 out of the 39 assessed drugs (51% of the national drug expenditure in 2021). Case examples of infliximab (e.g., wastage prevention) and intravenous immunoglobulins (e.g., lean body weight dosing) illustrate practical applications of the framework, resulting in substantial cost savings and improved sustainability.

Conclusions: This study presents a systematic scalable model for enhancing the cost-effectiveness of high-expenditure drugs in hospital settings. This approach not only addresses financial sustainability but also promotes the quality of patient care and sustainable drug use. This model could serve as a generic blueprint for other institutions to identify and implement cost-effective and sustainable drug use strategies.

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Conflict of interest statement

Declarations. Funding: This article was not supported by external funding. Conflicts of interest/competing interests: Annemarie C. de Vries has served on advisory boards for Takeda, Janssen, Bristol Myers Squibb, Abbvie, Pfizer, Lilly, and Galapagos and has received unrestricted research grants from Takeda, Janssen, Dr Falk, and Pfizer outside the submitted work. Roelof W.F. van Leeuwen reports research grants (all paid to the institution) from Bristol Myers Squibb, Pfizer, consulting fees from Bristol Myers Squibb, Roche, Pierre Fabre, AstraZeneca, Pfizer, Novartis, and Eli Lilly, speaker fees from AstraZeneca, and travel support from Ipsen, all outside the submitted work. Michiel Zietse, Shannon L. van der Zeeuw, Anne-Sophie Klein Gebbink, Marie-Rose B.S. Crombag, and Maaike J. Hoedemakers have no conflicts of interest that are directly relevant to the content of this article. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Availability of data and material: The data generated during the current study are available in the text and ESM. Further data can be made available from the corresponding author on reasonable request. Code availability: Not applicable. Authors’ contributions: MBSC, RWFL, and MJH conceptualized and designed this study. SZ, MBSC, RWFL, and MJH contributed to the data collection, MZ, SZ, MBSC, RWFL, and MJH contributed to the analysis. MZ, SZ, MBSC, RWFL, and MJH reviewed the available data. MZ, SZ, ASKG, ACV, MBSC, RWFL, and MJH drafted the manuscript. All authors read, commented, and approved the final manuscript, prior to submission.

Figures

Fig. 1
Fig. 1
This figure illustrates the ‘8-Step Efficiency Model’ developed for systematic evaluation of drug use sustainability and cost-effectiveness at the hospital level
See this image and copyright information in PMC

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