The effects of ceftriaxone by intravenous push on adverse drug reactions in the emergency department.

OBJECTIVE: At our hospital, a shortage of sterile saline bags led to changing ceftriaxone from intravenous infusion to intravenous push. We examined if this change led to an increase in adverse reactions. METHODS: We conducted a retrospective chart analysis on patients 18 and older that were administered ceftriaxone in the ED between January to March 2018. Research assistants recorded information about possible adverse reactions. Adverse reactions were defined as any noxious or unintended response to a drug given at therapeutic doses. Potential adverse reactions were independently reviewed by three EM clinicians and confirmed by an adverse drug reaction probability scale. The primary outcome was the rate of adverse reactions for IVP administration of ceftriaxone. RESULTS: 831 encounters were identified, 77 were excluded due to erroneous or missing data, and a total of 753 were included. Study demographics include an average age of 52.8, a female majority (54.2%) and predominantly black patient population (41.5%). A total of 24 cases were potential adverse reactions. After independent review, only one of the 24 cases was determined to be an adverse reaction to ceftriaxone from IVP. The total adverse event rate observed was 1/753 or 0.13%. CONCLUSIONS: Our study demonstrates that the rate of adverse reactions for IVP is lower than previously reported. Given the demonstrated safety of IVP administration, future studies are warranted to determine the implications for ED efficiency and cost benefits from this change in drug delivery.

Cost comparison of intrathecal morphine to intravenous patient-controlled analgesia for the first 24 h post cesarean delivery: a retrospective cohort study.

PURPOSE: Intrathecal morphine provides superior pain control for patients undergoing cesarean delivery when compared to intravenous opioid patient-controlled analgesia. However, no study has assessed the overall cost associated with each modality as a primary outcome. The aim of this study is to determine the overall cost of each modality for the first 24 h post cesarean delivery. METHODS: Charts of patients undergoing cesarean delivery at our institution from January 1, 2014 to December 31, 2014 were reviewed. Patients receiving intrathecal morphine were compared to patients undergoing general anesthesia and receiving intravenous opioid patient-controlled analgesia for post-procedure analgesia. The primary outcome measured was total cost of each modality for the first 24 h after delivery. Secondary outcomes included post-procedure pain scores, time to removal of the Foley catheter, need for rescue medications, and adverse events. RESULTS: There was a significant difference in total cost of intrathecal morphine when compared to intravenous opioid patient-controlled analgesia ($51.14 vs. $80.16, p < 0.001). Average pain scores between 0-1 h (0 vs. 5, p < 0.001) and 1-6 h (2.5 vs. 3.25, p < 0.001) were less in the intrathecal morphine group. The intrathecal morphine group received more ketorolac (p < 0.001) and required more rescue opioids (p = 0.042). There were no significant differences in documented adverse events. CONCLUSIONS: The use of intrathecal morphine for post-cesarean pain control leads to a significant cost savings for the first 24 h when compared to intravenous opioid patient-controlled analgesia. Patients also experienced less pain and were not at increased risk for adverse events.

An operational comparative study of quinine and artesunate for the treatment of severe malaria in hospitals and health centres in the Democratic Republic of Congo: the MATIAS study.

BACKGROUND: The Democratic Republic of the Congo (DRC) has the highest number of severe malaria cases in the world. In early 2012, the National Malaria Control Programme (NMCP) changed the policy for treating severe malaria in children and adults from injectable quinine to injectable artesunate. To inform the scaling up of injectable artesunate nationwide, operational research is needed to identify constraints and challenges in the DRC's specific setting. METHODS: The implementation of injectable quinine treatment in 350 patients aged 2 months or older in eight health facilities from October 2012 to January 2013 and injectable artesunate in 399 patients in the same facilities from April to June 2013 was compared. Since this was an implementation study, concurrent randomized controls were not possible. Four key components were evaluated during each phase: 1) clinical assessment, 2) time and motion, 3) feasibility and acceptability, and 4) financial cost. RESULTS: The time to discharge was lower in the artesunate (median=2, 90% central range 1-9) compared to the quinine group (3 (1-9) days; p<0.001). Similarly, the interval between admission and the start of intravenous (IV) treatment (2 (0-15) compared to 3 (0-20) hours; p<0.001) and parasite clearance time (23 (11-49) compared to 24 (10-82) hours; p<0.001) were lower in the artesunate group. The overall staff pre-administration time (13 (6-38) compared to 20 (7-50) minutes; p<0.001) and the personnel time spent on patient management (9 (1-24) compared to 12 (3-52) minutes; p<0.001) were lower in the artesunate group. In hospitals and health centres, the mean (standard deviation, SD) total cost per patient treated for severe malaria with injectable artesunate was USD 51.94 (16.20) and 19.51 (9.58); and USD 60.35 (17.73) and 20.36 (6.80) with injectable quinine. CONCLUSIONS: This study demonstrates that injectable artesunate in the DRC is easier to use and it costs less than injectable quinine. These findings provide the basis for practical recommendations for rapid national deployment of injectable artesunate in the DRC.

Comparison of oral and intravenous alfacalcidol in chronic hemodialysis patients.

BACKGROUND: Activated vitamin D is the mainstay of treatment for secondary hyperparathyroidism (SHPT) in chronic hemodialysis patients. However, the optimal route of administration is still debated. The aim of our study was to compare efficacy of oral vs intravenous (IV) administration of alfacalcidol in hemodialysis. A secondary objective was to determine the cost-effectiveness advantage of oral administration. METHODS: Eighty-eight chronic hemodialysis patients receiving IV alfacalcidol three times a week were included in the study. All were switched to the same dose of alfacalcidol given orally three times a week during the hemodialysis session. A budget impact analysis was performed. RESULTS: Mean patient age was 64 years old and 43% were males. The mean alfacalcidol dose administered was 2.1 µg three times a week. After three months, serum parathormone (PTH) levels decreased from 80 to 59 pmol/L (p = 0.001) and total serum calcium levels increased from 2.34 to 2.40 mmol/L (p = 0.002). After six months, total serum calcium levels were still significantly higher. Alfacalcidol dosage was significantly decreased during study period; the mean reduction was 0.44 µg per dose. Finally, oral administration was associated with an annual cost reduction of 197 678$CAN and an annual nursing time reduction of 25 days. CONCLUSION: Our findings support that switching IV to oral administration of alfacalcidol during hemodialysis sessions may lead to a similar control of SHPT with lower doses of activated vitamin D. This is a good strategy for optimizing compliance and may allow a dose reduction because of a greater efficacy to suppress PTH. Oral administration also has significant cost-effectiveness advantages.

Internet video to support intravenous medication administration in the home: a cost minimisation study.

We compared the costs associated with three different methods of administering antibiotics to paediatric oncology patients. In scenario A, medicine was prepared in the home, checked in the home using a video link to a second nurse, and administered in the home. In scenario B, medicine was prepared by outsourcing the work to a commercial organisation, checked by pharmacists off-site and administered in the home. In scenario C, medicine was prepared in the hospital, checked by a second nurse and administered in the outpatient department. The staff time required for home administration was calculated from actual home visits. The cost of tablet computers and mobile Internet charges for double-checks in the home was based on an assumed useful life of 3 years for the equipment. The cost of outsourcing the preparation of medications was calculated from the actual cost of doing so during a four month period. Patient outcome was assumed to be the same in all three scenarios. The mean costs of a medication episode (i.e. one occasion of medication administration) was $129.91 in scenario A, $312.00 in scenario B and $355.91 in scenario C. Nurse preparation and administration in the home would save the oncology health service $124,899 per annum compared to outsourcing medication preparation. Nurse preparation and administration in the home would save the oncology health service $155,329 per annum compared to nurse preparation and administration in the outpatient department. Use of Internet-based video appears to produce savings compared to other methods of administering antibiotics and the technique may have wider application in supporting complex interventions in the home.

Gammaglobulina subcutánea en inmunodeficiencia común variable. Primera experiencia en España / Subcutaneous gammaglobulin in common variable immunodeficiency. First experience in Spain

Introducción y objetivo: la autoadministración semanal de gammaglobulina subcutánea (GGSC) domiciliaria es una alternativa en el tratamiento de las inmunodeficiencias primarias con déficit de producción de anticuerpos. El objetivo es comparar y evaluar la eficacia, la seguridad, la calidad de vida y el coste anual de GGSC y gammaglobulina intravenosa (GGIV) en nuestro medio. Material y métodos: estudio observacional y descriptivo de los pacientes pediátricos con inmunodeficiencia común variable (IDCV) que reciben GGSC en nuestro centro (noviembre 2006-abril 2008), en comparación con el último año de GGIV. Resultados: se incluyó a 11 pacientes afectos de IDCV. Mediana de edad, 15 años. Mediana de IgG plasmática valle con GGIV, 622 mg/dl. En los pacientes en que se mantuvo o se disminuyó la dosis de GGSC respecto a la de GGIV previa (7/8), la mediana de IgG fue 850 mg/dl (p<0,0005). Tasa de infección/paciente/año de 2,22, sin diferencias estadísticamente significativas respecto a GGIV (p=0,212). Se produjeron 58 reacciones adversas (45 locales, 13 sistémicas) en 41/506 infusiones. Las reacciones adversas locales más frecuentes fueron dolor y picor y como sistémicas, la cefalea. Todos los pacientes refirieron una mejora en su calidad de vida. El tratamiento con GGSC supuso un importante ahorro económico. Conclusiones: la terapia subcutánea es una alternativa coste-efectiva a la GGIV con una eficacia similar y un aumento de calidad de vida en los pacientes con IDCV. Las concentraciones plasmáticas valle de IgG obtenidas son iguales o mayores. Las reacciones adversas locales son frecuentes, pero leves y autolimitadas (AU)

Introduction and aim: Weekly home-based subcutaneous immunoglobulin (SCIg) therapy is an alternative to intravenous immunoglobulin (IVIg) in the treatment of patients with primary antibody deficiencies. The objective of this study was to investigate the efficacy, safety, related quality of life and cost effectiveness of SCIg in our area. Materials and methods: Observational and descriptive study including paediatric patients with common variable immunodeficiency (CVID) receiving SCIg in our hospital (November 2006 to April 2008). Obtained data were compared with those from the last year with IVIg. Results: Eleven patients with CVID were included. Median age was 15 years. The median trough serum IgG level was 622mg/dl with IVIg. In patients in whom the SCIg dose was maintained or reduced compared to IVIg, the median trough serum IgG level was 850mg/dl (p<0.0005). Annual rate of infection was 2.22 per patient-year, without significant differences to IVIg (p=0.212). There were 58 treatment-related adverse events (AE) reported with SCIg (45 local AE and 13 systemic AE). The most frequent treatment-related adverse event was infusion-site reaction. Switching to home-based subcutaneous IgG treatment led to significant improvements in quality of life and substantial cost savings. Conclusions: We conclude that subcutaneous administration of 16% SCIg is a safe and cost-effective alternative to IVIg for replacement therapy of primary antibody deficiencies. Median trough serum IgG levels were higher with SCIg. Local AE were common but mild and the incidence decreased over time. Quality of life is significantly improved (AU)

Costes de la neumonía en FPH Verín / Cost of pneumonia in the FP Hospital Verín

El objetivo de este artículo es el calcular el coste real de la neumonía en la Fundación Pública Hospital Verín y determinar su eficencia económica. Se analizan también factores determinantes del coste en el tratamiento que conllevarían paejos ahorros improtantes como es el caso de la vía de adminsitración de la medicación donde se concluye que el coste del tratameinto se puede eevar hasta 10 veces más sie lmismo medicamento y la misma dosis se da vía venosa en vez adminsitrarse oralmente (AU)

The aim of this article is to calculate the real cost of pneumonia in the Foundation Pública Hospital Verin and to determine its financial efficiency. It also analyses determining factors in the cost of treatment which would ear to important savings such as the case of the route of administration of the medication where it concludes that the cost of the treatment can be 10 times more as expensive than if the same medicine and the same dose is administered intravenously instead of orally (AU)

Antiemetic use in acetaminophen poisoning: how does the route of N-acetylcysteine administration affect utilization?

INTRODUCTION: We sought to compare antiemetic use after acetaminophen poisoning in patients treated with oral or intravenous (IV) N-acetylcysteine (NAC). METHODS: Our retrospective chart review identified 20 orally treated patients and 17 IV-treated patients. For both groups, we calculated the total number of antiemetic doses given, their associated cost, and also determined parameters that correlated with antiemetic use. RESULTS: IV-treated patients received fewer total antiemetic doses than those receiving oral NAC (1.1 0.2 vs. 2.8 0.7; P 0.04). Antiemetic cost correlated with doses received for both groups; however, because the regression lines differed (P 0.02), antiemetic therapy cost was less in IV-treated patients. In addition, serum acetaminophen concentration correlated with total antiemetic doses in oral NAC patients (P 0.002) but not with IV treatment patients (P 0.78). CONCLUSIONS: Intravenous NAC reduced antiemetic utilization, and it costs less than oral therapy. Furthermore, antiemetic use appeared to be determined by a combination of acetaminophen concentration and NAC administration route.

A change from subcutaneous to intravenous erythropoietin increases the cost of anemia therapy.

BACKGROUND: It seems that more erythropoietin (EPO) is required when given intravenously (IV) than when given subcutaneously (SC). Estimates of the magnitude of this difference vary widely, impeding development of economic models in this area. Concerns about pure red cell aplasia led our program to switch from SC to IV EPO, so we studied the impact of this change on the cost of anemia therapy. METHODS: All in-center hemodialysis patients who had received EPO for at least 3 months prior to and following conversion to IV EPO were studied. Data was obtained retrospectively for 1 year prior to and prospectively for 1 year following conversion. The costs of anemia therapy (EPO, transfusions and iron) were calculated from the hospital's perspective. RESULTS: 158 patients were studied. One month after switching, the hemoglobin fell significantly, reaching a nadir at 3 months. This triggered more use of EPO, iron and transfusions. By month 7 hemoglobin levels had returned to initial levels, with a median rise in EPO dose of 1,250 units/week (p < 0.001). After the switch, the median rise in total anemia therapy costs was 13.1% (CAD 665/patient-year, p < 0.01). CONCLUSIONS: Conversion of EPO from SC to IV dosing increased the costs of anemia therapy at our center.

[Costs of a cytostatic drug preparation unit in a hospital in Mexico]. / Costes de una unidad de preparación de citostáticos en un hospital de México.

OBJECTIVE: To estimate the cost of preparing cytostatic drugs in the intravenous preparation unit in a hospital in Mexico. METHOD: The annual cost of preparing cytostatic drugs based on the information of 92 days, considering the costs of drugs, the mixing service (including standard solution, quality control, services and waste) and salaries were estimated. The costs are estimated in Mexican pesos in 2006. RESULTS: The cost per cytostatic drug varies from 82 to 23,000 Mexican pesos, depending on the type of drug used. It is estimated that the annual cost of preparing drugs for chemotherapy is 38,901,231.04 Mexican pesos (2,839,505.02 euro) distributed as follows: 96.8% for drug costs, 1.21% for staff salaries and 1.99% for the preparation service. CONCLUSIONS: The estimation of the costs of preparing cytostatic drugs serves as a reference for future economic studies in the hospital pharmacy area in Mexico.

Cost minimisation and cost effectiveness in anaesthesia for total hip replacement surgery, in Belgium? A study comparing three general anaesthesia techniques.

The aim of the prospective randomised study is to compare the cost effectiveness of three general anaesthesia techniques for total hip replacement surgery and the cost minimisation by use of anaesthetics. For induction propofol was used in the three techniques. For maintenance, we used desflurane, or sevoflurane, or propofol. There was no significant difference in consumption of drugs for pain treatment, treatment of nausea and vomiting or cost of hospital stay or total cost for pharmacy. In terms of cost-effectiveness we can consider that the three techniques are similar. The cost of an i.v. technique was always higher than inhaled anaesthetics. The major cost in anaesthesia is the fee for the anaesthesiologist. But all in, the cost of anaesthesia was only 15.1% of the total cost of the procedure. Cost of inhaled or i.v. anaesthetics was 0.55% to 1.0% of the total cost. There was a discrepancy between the measured consumption of inhaled anaesthetics and the consumption (and cost) on the invoice. Cost minimisation based on anaesthetic medication is ridiculously by small considering the total cost of the procedure.

Evaluation of an antibiotic intravenous to oral sequential therapy program.

AIM: This study was designed to analyse the drug consumption difference and economic impact of an antibiotic sequential therapy focused on quinolones. METHOD: We studied the consumption of quinolones (ofloxacin/levofloxacin and ciprofloxacin) 6 months before and after the implementation of a sequential therapy program in hospitalised patients. It was calculated for each antibiotic, in its oral and intravenous forms, in defined daily dose (DDD/100 stays per day) and economical terms (drug acquisition cost). At the beginning of the program ofloxacin was replaced by levofloxacin and, since their clinical uses are similar, the consumption of both drugs was compared during the period. RESULTS: In economic terms, the consumption of intravenous quinolones decreased 60% whereas the consumption of oral quinolones increased 66%. In DDD/100 stays per day, intravenous forms consumption decreased 53% and oral forms consumption increased 36%. CONCLUSIONS: Focusing on quinolones, the implementation of a sequential therapy program based on promoting an early switch from intravenous to oral regimen has proved its capacity to alter the utilisation profile of these antibiotics. The program has permitted the hospital a global saving of 41420 dollars for these drugs during the period of time considered.

Elaboración en farmacia de los medicamentos intravenosos / Producing intravenous medications in a pharmacy

Se explican las diferentes mezclas intravenosas (MIV) y jeringas precargadas elaboradas en una unidad centralizada, analizando su rentabilidad y evaluando su repercusión en el trabajo diario de enfermería. El estudio se realizó en el Hospital de Poniente de Almería, hospital comarcal de 165 camas. Se definen los medicamentos candidatos a su preparación centralizada en el Servicio de Farmacia y se elabora una lista-guía con sus condiciones de conservación. Se determinó el tiempo que emplearía el personal de enfermería de las diferentes unidades de hospitalización en su elaboración comparándolo con el empleado en el Servicio de Farmacia (AU)