Cost-reduction strategy for isoproterenol use in radiofrequency catheter ablation procedures.

PURPOSE: A cost-reduction strategy for isoproterenol use in radiofrequency catheter ablation procedures was evaluated. SUMMARY: A medication-use evaluation at a 454-bed tertiary medical center revealed that the cardiac catheterization laboratory was the highest user of isoproterenol. Isoproterenol was removed from all AcuDose-Rx machines Omnicell, Mountain View, CA, and compounding was performed by pharmacy personnel. It was initially provided to the cardiac catheterization laboratory as an 8-µg/mL concentration in 20-mL 0.9% sodium chloride injection syringes with a 24-hour beyond-use date. This resulted in an initial cost savings but with an unacceptably high rate of wastage. Isoproterenol was then compounded as a 4-µg/mL concentration in 30 mL 5% dextrose in water syringes with a 9-day beyond-use date after a thorough literature search supported longer stability with this admixture. After 12 months of our current process, isoproterenol use during radio frequency catheter ablations (RFCAs) in the cardiac catheterization laboratory was reduced by 85%, decreasing the number of ampules used from 11.15 to 1.66 per week. CONCLUSION: A pharmacy-initiated process to mitigate an extraordinary increase in isoproterenol acquisition cost resulted in a reduction in usage in a tertiary care community hospital. Isoproterenol usage was reduced 85% after two different interventions were implemented, which is estimated to save $1,839 per procedure.

Hyperinflation of Isoproterenol.

The hyperinflation of isoproterenol, a 75-year-old drug, in early 2015 was unbelievable. The attention of health-care professionals, health system administrators, legislators, and the general public was quickly focused on Valeant Pharmaceuticals, purchaser of several generics solely to raise their price. With isoproterenol easily launched toward the top of drug expenditures, pharmacists in many hospitals were forced to engage stakeholders in the investigation and implementation of alternatives, explore utilization and optimize inventory, reduce cost through sterile product preparation, where possible, restrict use to settings that were beneficial to their budget, and become legislative advocates. The alternatives drugs and strategies will be reviewed.

[Respective interest of two techniques of electrophysiological study in patient without heart disease]. / Intérêt respectif de deux techniques d'etude electrophysiologique chez un sujet 'a coeur apparemment sain.

UNLABELLED: Electrophysiologic study (EPS) frequently is required to assess the prognosis of asymptomatic Wolff-Parkinson-White syndrome (WPW) or to prove the nature of no documented tachycardia. EPS usually is performed by intracardiac route and hospitalization is required. Similar data are given by an EPS performed by oesophageal route during a consultation. The purpose of the study was to evaluate the cost of both techniques in France. Transesophageal EPS was performed during a consultation in 100 patients with asymptomatic WPW syndrome and 100 patients with no heart disease, complaining of no documented tachycardias with abrupt beginning and end, suggesting a paroxysmal junctional re-entrant tachycardia (PJRT). The cost of transesophageal study including isoproterenol infusion is 127.75 euros. The cost of intracardiac EPS is at least 1460 euros, cost of hospitalization during only one day. RESULTS: In patients with WPW syndrome, 15 had a potentially malignant form with the induction of a tachycardia conducted through the accessory pathway at a high rate (> 240/min in control state, > 300/min with isoproterenol); radiofrequency catheter ablation was indicated in a second time. In the group with no documented tachycardia, PJRT was induced in 30 patients and indication of ablation was discussed. In other 155 patients with either a benign form of WPW syndrome or with a tachycardia unrelated to a PJRT, hospitalization was not required; in these patients, intracardiac study performed during one day of hospitalization would have costed 226,300 Euros. The cost for the esophageal EPS and a similar diagnosis was 19,801 Euros, with a save money of 206,499 Euros. In 45 patients in whom hospitalization was indicated in a second time to perform catheter ablation of the arrhythmia, the cost related to esophageal EPS was 5749 Euros. In the total group, considering the final diagnosis and the need of hospitalization in 45 patients, the save money related to the use of esophageal EPS was 206,499 E-5749 E = 200,750 euros. CONCLUSIONS: We should take into account the cost studies, when various techniques could be used for a similar diagnosis. There are important differences in the cost of diagnostic methods and it is easy to decrease this cost.