Thursday Jan 20, 2005
Delancey, NYC
Special Marc SOLO performance
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By Prescription Medications Online

There is more to choosing drugs for the intensive care unit than cost. How effective a particular agent is may be even more important than how much it costs.

"Pharmaceuticals are not cheap, especially not in the ICU," said Joseph Dasta, pharmacy professor at Ohio State University College of Pharmacy. "Drugs are the fastest-growing category of healthcare expenditures, and the ICU accounts for 40% of total hospital drug expenditures in some very credible studies," he told the Society of Critical Care Medicine's 35th Critical Care Congress in San Francisco. "We shouldn't target the expensive drug, even though it is almost a reflex to do so. We should be looking for the most cost-effective drug because it is the cheapest in the larger scheme of the hospital."

Acquisition cost is only one factor that goes into the overall cost of a drug, Dasta continued. Material and labor costs, preparation costs, administration costs, route of administration, dosing schedule, length of stay, and other factors all play a role in the total drug spend.

The accounting department may question the use of intravenous gentamicin in the ICU, for example, noting that oral formulations are much less expensive. Tablets may indeed be cheaper, Dasta noted, but the oral formulation must be administered three times a day. Every occasion offers new potential for a missed dose, wrong dose, wrong drug, wrong patient, and other mishaps.

Administering the same drug by IV starts with a more expensive formulation, but the other factors lower costs. An entire day's supply of antibiotic can be loaded on a programmable IV pump that administers the appropriate dose every eight hours. That eliminates two nursing visits.

Automated administration also avoids missed doses and other safety issues associated with the manual drug administration process. "Cost and quality are in constant conflict," Dasta explained. "The shift needs to move to quality over cost of care. Cost-effectiveness, not cost, is the true measure of performance."

Expect to see more emphasis on cost-effectiveness, Dasta said. As the federal government and other payers introduce pay-for-performance measures to hospital care, they are creating new incentives to track the cost of disease as well as the most cost-effective way to deal with it.


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