Comparison of vials and prefilled pens of a rapid-acting insulin analog on pharmacy budgets in a long-term care setting.

OBJECTIVE: Estimate budgetary impact for skilled nursing facility converting from individual patient supply (IPS) delivery of rapid-acting insulin analog (RAIA) 10-mL vials or 3-mL prefilled pens to 3-mL vials. DESIGN: A budget-impact model used insulin volume purchased and assumptions of length of stay (LOS), daily RAIA dose, and delivery protocol to estimate the cost impact of using 3-mL vials. SETTING: Skilled nursing facility. PARTICIPANTS: Medicare Part A patients. INTERVENTIONS: Simulations conducted using 12-month current and future scenarios. Comparisons of RAIA use for 13- and 28-day LOS. MAIN OUTCOME MEASURES: RAIA costs and savings, waste reduction. RESULTS: For patients with 13-day LOS using 20 units/day of IPS insulin, the model estimated a 70% reduction in RAIA costs and units purchased and a 95% waste reduction for the 3-mL vial compared with the 10-mL vial. The estimated costs for prefilled pen use were 58% lower than for use of 10-mL vials. The incremental savings associated with 3-mL vial use instead of prefilled pens was 28%, attributable to differences in per-unit cost of insulin in vials versus prefilled pens. Using a more conservative scenario of 28-day LOS at 20 units/day, the model estimated a 40% reduction in RAIA costs and units purchased, resulting in a 91% reduction in RAIA waste for the 3-mL vial, compared with 10-mL vial. CONCLUSION: Budget-impact analysis of conversion from RAIA 10-mL vials or 3-mL prefilled pens to 3-mL vials estimated reductions in both insulin costs and waste across multiple scenarios of varying LOS and patient daily doses for skilled nursing facility stays.

Economic Impact of Converting from Pen and 10-mL Vial to 3-mL Vial for Insulin Delivery in a Hospital Setting.

PURPOSE: To compare the impact on acquisition cost and purchased volume of rapid- and short-acting insulins following conversion from 3-mL disposable pens and 10-mL vials to 3-mL vials for individual patient supply (IPS) in a hospital setting. METHODS: On February 1, 2010, St. Joseph's Hospital and Medical Center of Dignity Health in Phoenix, Arizona, converted from pens to 3-mL vials for IPS subcutaneous (SC) injection and from 10-mL short-acting insulin vials to 3-mL vials for intravenous (IV) preparation. Pharmacy purchasing data were analyzed over 6-month periods before and after conversion (March 1 through August 31, 2009, and March 1 through August 31, 2010). RESULTS: Before conversion, acquisition costs were $27,866 for 5,335 mL of rapid-acting insulins and $53,336 for 26,310 mL of short-acting insulins. After conversion, insulin acquisition costs were $24,211 for 5,850 mL of rapid-acting insulins (13.1% decrease in costs, 9.7% rise in volume), with cost reduction attributable to the lower cost of 3-mL vials. Acquisition costs were $17,395 for 14,700 mL of short-acting insulins after conversion (67.4% decrease in costs, 44.1% reduction in volume), with cost reduction attributable to lower cost of 3-mL vials versus pens for IPS SC injections and 10-mL vials for IV preparation. The reduction in purchased volumes of short-acting insulins may be partly due to decreased insulin use in IV preparation. CONCLUSION: Conversion from pens and 10-mL vials to 3-mL vials for rapid-and short-acting insulins resulted in reduced acquisition costs and decreased use of short-acting insulin in IV preparations.

Effects of prototypical microsomal enzyme inducers on cytochrome P450 expression in cultured human hepatocytes.

Cultured human hepatocytes are a valuable in vitro system for evaluating new molecular entities as inducers of cytochrome P450 (P450) enzymes. The present study summarizes data obtained from 62 preparations of cultured human hepatocytes that were treated with vehicles (saline or dimethylsulfoxide, 0.1%), beta-naphthoflavone (33 microM), phenobarbital (100 or 250 microM), isoniazid (100 microM) and/or rifampin (20 or 50 microM), and examined for the expression of P450 enzymes based on microsomal activity toward marker substrates, or in the case of CYP2C8, the level of immunoreactive protein. The results show that CYP1A2 activity was markedly induced by beta-naphthoflavone (on average 13-fold, n = 28 preparations), and weakly induced by phenobarbital (1.9-fold, n = 25) and rifampin (2.3-fold, n = 22); CYP2A6 activity tended to be increased with phenobarbital (n = 7) and rifampin (n = 3) treatments, but the effects were not statistically significant; CYP2B6 was induced by phenobarbital (6.5-fold, n = 13) and rifampin (13-fold, n = 14); CYP2C8 was induced by phenobarbital (4.0-fold, n = 4) and rifampin (5.2-fold, n = 4); CYP2C9 was induced by phenobarbital (1.8-fold, n = 14) and rifampin (3.5-fold, n = 10); CYP2C19 was markedly induced by rifampin (37-fold, n = 10), but relatively modestly by phenobarbital (7-fold, n = 9); CYP2D6 was not significantly induced by phenobarbital (n = 5) or rifampin (n = 5); CYP2E1 was induced by phenobarbital (1.7-fold, n = 5), rifampin (2.2-fold, n = 5), and isoniazid (2.3-fold, n = 5); and, CYP3A4 was induced by phenobarbital (3.3-fold, n = 42) and rifampin (10-fold, n = 61), but not by beta-naphthoflavone. Based on these observations, we generalize that beta-naphthoflavone induces CYP1A2 and isoniazid induces CYP2E1, whereas rifampin and, to a lesser extent phenobarbital, tend to significantly and consistently induce enzymes of the CYP2A, CYP2B, CYP2C, CYP2E, and CYP3A subfamilies but not the 2D subfamily.