It is frightening to consider the costs behind the large amount of drugs used to treat patients today. Fortunately, a recent study at Hopkins Hospital led by Brandyn Lau and colleagues shows that potentially millions of dollars can be saved each year by simply replacing intravenous medications for pills in hospitalized patients who are capable of swallowing.
The study utilized computerized records at the Hopkins Hospital for 2010. From these records, researchers estimate a total of 1.1 million dollars can be saved from just the Department of Medicine alone, not counting surgical patients, if four commonly prescribed IV medications were exchanged for their oral counterparts.
The four IVs considered for this study were chlorothiazide, voriconazole, levetiracetam and pantoprazole. These drugs are used to prevent high blood pressure, fungal infections, seizures and acid reflux respectively. Researchers chose these medications in particular because of the high similarity between the IV and oral forms. However, many other drugs can potentially be swapped as well.
In this study, IV medication administration for inpatients was first correlated with diet order status. Those who were able to feed through their mouth were labeled as eligible for the switch from IV to oral drug intake. Those who cannot eat this way were manually reviewed for other indicators of switch eligibility.
Research indicates that approximately 12 percent of United States' health expenditures in 2009 were spent on medications, amounting to a total of $293.2 billion. In hospitals, the cost of drugs accounts for up to eight percent of total cost, significantly adding to the cost of patient care.
Furthermore, IV medications are generally more expensive compared to their oral equivalents. Thus, by simply switching eligible patients to oral medications as soon as they qualify, hospitals can greatly reduce costs associated with IV administration. Moreover, this will also reduce risks associated with bloodstream infections, cellulitis and other side effects associated with IV access that may result in longer hospital stays.
Although not all patients can switch from IV to oral medications, even a small portion of switches will substantially reduce hospital costs. Patients who are prescribed other orally taken drugs or are able to consume solid meals are generally eligible for the swap from IV drugs to oral equivalents.
One potential limiting factor to the implementation of this plan is the difficulty of encouraging physicians to switch without over-reminding them to the point of annoyance. Medical facilities can add alert systems that indicate when a patient on an IV drug qualifies for the oral version. However, considering the number of notifications doctors get, one must be cautious of how to raise awareness amongst physicians.
The researchers behind this study suggest that one potential avenue to resolve this problem is through education. Teaching doctors the cost effectiveness of oral medications over intravenous ones may be more effective than constant reminders.
A limitation to this study is the lack of consideration for all complicating factors, which include stability of patient cases over time, product prices over time, and medical practice patterns in different facilities.
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