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Executive Summary

VANCOMYCIN INDIVIDUALIZED DOSING CAN RESULT IN 2-3% COST SAVINGS per patient, according to a presentation made at the American Society of Hospital Pharmacists' midyear clinical meeting Dec. 7-11 in Las Vegas, Nevada. "Individualization of vancomycin dosage regimens can make a measurable impact on a patient's total hospital charges, and we believe we are seeing something in the area of 2-3%," Columbus, Ohio pharmacist Mark Millikan, Riverside Methodist Hospital, concluded. Along with colleagues Teresa Bosh and David Grauer, Millikan described a 21-month vancomycin (Lilly's Vancocin) dosing study in which savings of $14,000 were realized with 59 hours of pharmacy intervention after initial treatment began. The savings translate roughly to $237 per hour of pharmacist time spent monitoring patient serum levels. In general, the investigators found that daily dosing of vancomycin was decreased and dosing intervals were lengthened from the standard 500 mg q.i.d., in order to achieve the target peak/trough serum concentrations. "Break even analysis suggests that serum level monitoring on day three [of vancomycin therapy] would be appropriate in most cases, in terms of resulting cost to/ patients," Millikan added. "Our break even analysis also suggests that rational initial dosing could result in further cost savings. Clinical pharmacy managers should consider including vancomycin as part of their pharmacokinetic services." Introduced in the 1950s, vancomycin has, within the last few years, become the therapy of choice for most methicillin-resistant infections, the investigators pointed out. The drug's relatively high price tag has focused the attention of cost conscious hospital pharmacists. On the basis of a 73-patient study, James Rhodes, Childrens Hospital in Washington, D.C., said that inappropriate vancomycin therapy carried out in 26% of the patients indicated "a definite need for improved vancomycin utilization in our institution." The pharmacist's role in hospital cost-containment was also emphasized by health care consultant Paul Sanazaro, MD, in his keynote address to the ASHP mid-year meeting. "Technology, as reflected in drugs and prices, is your springboard for the future," he said. "Despite the enormous expenditures by drug companies, medical organizations and hospitals on continuing education," he asserted, "there are serious deficiencies about the way drugs are prescribed in American hospitals." Similarly, "in your educational efforts, you all ought to be able to publicize the truth fully when you see a trend in prescribing that is away from inexpensive, effective drugs to more expensive, less effective drugs," Sanazaro told the audience. "This is what has happened, apparently, in the treatment of mild to moderate hypertension, where there has been a movement away from diuretics to ACE inhibitors and calcium channel blockers as drugs of first choice rather than drugs to turn to when the first choice drugs don't work." In addition, Sanazaro called adverse drug reaction reporting a "fertile field" for pharmacists. "In my observations, the number of reported drug reactions in hospitals is considerably below what we all know to be the case," he said. Sanazaro asserted that a major function of quality assurance is "to help prevent preventable adverse outcomes" and "I am merely trying to show you there is a fertile field of opportunity in this area."

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