Pills Could Save Millions

Switching from intravenous drugs to pills could result in significant financial savings

(RxWiki News) When it comes to saving money in hospitals, a key may be medication form. Switching hospitalized patients from IV drugs to pill versions of the same medications could result in saving millions.

Johns Hopkins Hospital researchers estimate its Department of Medicine alone without including surgical patients could save $1.1 million by making the switch of only four common IV medicines.

"Ask if oral medication might be appropriate."

Brandyn D. Lau, a medical informatics specialist at the Johns Hopkins University School of Medicine and the study’s leader, said the study examined only four drugs administered in one hospital department over a year, finding potential savings of more than a million. He imagines the savings could be tremendous if every hospital took a hard look at substituting oral medications for IV drugs when possible, and there would be no risk to patients.

In addition to reducing costs, a major shift to oral medications could reduce the need to puncture veins for intravenous tubes or medications, which carry a risk of hospital-acquired bloodstream infections and longer hospital stays. He said even reminding doctors that patients may be eligible to switch medication form could result in substantial savings.

The Center's for Medicare and Medicaid Services estimates that about 12 percent of U.S. healthcare expenditures in 2009 went toward medications and nondurable medical products.

Researchers reviewed 2010 computerized records at Johns Hopkins Hospital in making the finding. The four medications reviewed in the study were chlorothiazide, used to treat high blood pressure and fluid retention; voriconazole, an anti-fungal; levetiracetam, given to stop seizures; and pantoprazole for acid reflux. A total of 10,905 doses of the medications were given to IV patients admitted through the Department of Medicine in 2010.

Investigators examined whether patients receiving these IV drugs were also prescribed other medications orally of if they were fed solid meals, an indication they could likely swallow pills.

Results were compared to the common costs of medications. As an example, the wholesale cost of a 5-milligram tablet of chlorothiazide is $1.48, while an equivalent IV dose costs $357.24. Pantoprazole, found to be the most commonly medication in the study, costs $4.09 per 40-milligram tablet, while a 40-milligram vial costs $144.  Patients often require several daily doses of the drug.

Though not all patients could switch to a pill form, Lau said hospitals with computerized medication systems could add program alerts that show up when a patient meets eligibility to take medicines orally. Teaching doctors that the oral medications are cheaper also could encourage the switch, he said.

The study was recently published in the journal Clinical Therapeutics.

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Review Date: 
October 31, 2011