Hospitals have a huge potential for saving money by using alternative drugs, according to new Johns Hopkins research.
Switching hospitalized patients from intravenous drugs to pill forms of the same medications could save hospitals millions of dollars a year. In a review of 2010 computerized records, conducted at the Johns Hopkins Hospital in Baltimore, researchers estimated savings of more than $1.1 million in the Johns Hopkins Department of Medicine alone – not including surgical patients – by swapping out four commonly prescribed IV medications with their oral equivalents.
That’s a significant opportunity for cost savings, considering that roughly 12 percent of U.S. healthcare expenditures in 2009 — or $293.2 billion — accounted for medications and nondurable medical products, according to the Centers for Medicare and Medicaid Services.
A report on the Hopkins study was published in the medical journal Clinical Therapeutics this month.
"Imagine if every hospital took a hard look at substituting oral medications for IV ones whenever possible. We’re talking about an enormous financial impact, with no risk to patients,” says Brandyn D. Lau, a medical informatics specialist at the Johns Hopkins University School of Medicine and the study’s lead researcher.
Lau says a large-scale switch to oral medications has the potential to not only decrease costs, but to also reduce the need for puncturing veins to insert intravenous tubes or medications directly, procedures that carry a higher risk of hospital-acquired bloodstream infections and longer hospital stays. Simple reminders to physicians that their patients may be eligible to switch medication types could yield large savings, the researchers say.
The four medications reviewed in the study were chlorothiazide, a medication used to treat high blood pressure and address fluid retention; voriconazole, an anti-fungal; levetiracetam, which is used to stop seizures; and pantoprazole, used to treat acid reflux.
Researchers examined whether patients receiving these drugs intravenously were also prescribed other medications orally or if they were being fed solid meals, an indication that they would likely be able to swallow pills.
These four drugs were selected for the study because the oral and IV forms are very similar to one another, but many other drugs potentially could be swapped out for greater cost savings.
In 2010, a total of 10,905 doses of the four medications were given by IV to patients admitted through the Johns Hopkins Department of Medicine. The drugs are given even more frequently in surgery patients. The authors of the study compared those results with the cost of the various medications prescribed to patients. For example, the wholesale cost of a 5-milligram tablet of chlorothiazide is $1.48. An equivalent dose of the drug given intravenously is $357.24, more than 200 times as much as the oral version.
Similarly, pantoprazole, the most commonly administered medication in the study, is $4.09 per 40-milligram tablet, while a 40-milligram IV vial is $144. That medication is often given to patients several times a day. The potential cost savings per patient for the acid reflux medication would be $680.98, the researchers found.
While hospitals could save money by administering the pill form of these drugs to patients instead of the IV form, not all patients are able to make the switch. Diet orders may change or a physician may have a reason for not switching a particular patient to an oral medication.
But the study shows that even a small increase in the conversion of patients from IV to oral medication would have a substantial financial impact due to the considerable difference in costs between the two forms.
To implement the swaps, Lau says hospitals with computerized medication systems could add alerts to their programs that would appear when a patient on an IV medication meets eligibility criteria for oral medication intake.