Impact of displaying inpatient pharmaceutical costs at the time of order entry: Lessons from a tertiary care center

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Abstract

BACKGROUND: A lack of cost-conscious medication use is a major contributor to excessive healthcare expenditures in the inpatient setting. Expensive medicines are often utilized when there are comparable alternatives available at a lower cost. Increasing prescriber awareness of medication cost at the time of ordering may help promote cost-conscious use of medications in the hospital. OBJECTIVE: To evaluate the impact of cost messaging on the ordering of 9 expensive medications. DESIGN: Retrospective analysis of an institutional cost-transparency initiative. SETTING: A 1145-bed, tertiary care, academic medical center. PARTICIPANTS: Prescribers who ordered medications through the computerized provider order entry system at the Johns Hopkins Hospital. METHODS: Interrupted time series and segmented regression models were used to examine prescriber ordering before and after implementation of cost messaging for 9 highcost medications. RESULTS: Following the implementation of cost messaging, no significant changes were observed in the number of orders or ordering trends for intravenous (IV) formulations of eculizumab, calcitonin, levetiracetam, linezolid, mycophenolate, ribavirin, and levothyroxine. An immediate and sustained reduction in medication utilization was seen in 2 drugs that underwent a policy change during our study, IV pantoprazole and oral voriconazole. IV pantoprazole became restricted at our facility due to a national shortage (-985 orders per 10,000 patient days; P < 0.001), and oral voriconazole was replaced with an alternative antifungal in oncology order sets (–110 orders per 10,000 patient days; P = 0.001). CONCLUSIONS: Prescriber cost transparency alone did not significantly influence medication utilization at our institution. Active strategies to reduce ordering resulted in dramatic reductions in ordering.

Original languageEnglish (US)
Pages (from-to)639-645
Number of pages7
JournalJournal of Hospital Medicine
Volume12
Issue number8
DOIs
StatePublished - Aug 1 2017

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Tertiary Care Centers
Inpatients
Costs and Cost Analysis
Pharmaceutical Preparations
Linezolid
etiracetam
Medical Order Entry Systems
Ribavirin
Calcitonin
Tertiary Healthcare
Health Expenditures
Thyroxine
Delivery of Health Care

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

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title = "Impact of displaying inpatient pharmaceutical costs at the time of order entry: Lessons from a tertiary care center",
abstract = "BACKGROUND: A lack of cost-conscious medication use is a major contributor to excessive healthcare expenditures in the inpatient setting. Expensive medicines are often utilized when there are comparable alternatives available at a lower cost. Increasing prescriber awareness of medication cost at the time of ordering may help promote cost-conscious use of medications in the hospital. OBJECTIVE: To evaluate the impact of cost messaging on the ordering of 9 expensive medications. DESIGN: Retrospective analysis of an institutional cost-transparency initiative. SETTING: A 1145-bed, tertiary care, academic medical center. PARTICIPANTS: Prescribers who ordered medications through the computerized provider order entry system at the Johns Hopkins Hospital. METHODS: Interrupted time series and segmented regression models were used to examine prescriber ordering before and after implementation of cost messaging for 9 highcost medications. RESULTS: Following the implementation of cost messaging, no significant changes were observed in the number of orders or ordering trends for intravenous (IV) formulations of eculizumab, calcitonin, levetiracetam, linezolid, mycophenolate, ribavirin, and levothyroxine. An immediate and sustained reduction in medication utilization was seen in 2 drugs that underwent a policy change during our study, IV pantoprazole and oral voriconazole. IV pantoprazole became restricted at our facility due to a national shortage (-985 orders per 10,000 patient days; P < 0.001), and oral voriconazole was replaced with an alternative antifungal in oncology order sets (–110 orders per 10,000 patient days; P = 0.001). CONCLUSIONS: Prescriber cost transparency alone did not significantly influence medication utilization at our institution. Active strategies to reduce ordering resulted in dramatic reductions in ordering.",
author = "{Johnson Conway}, Sarah and Daniel Brotman and Pinto, {Brian L.} and David Merola and Leonard Feldman and Redonda Miller and Shermock, {Kenneth M}",
year = "2017",
month = "8",
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doi = "10.12788/jhm.2779",
language = "English (US)",
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pages = "639--645",
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TY - JOUR

T1 - Impact of displaying inpatient pharmaceutical costs at the time of order entry

T2 - Lessons from a tertiary care center

AU - Johnson Conway, Sarah

AU - Brotman, Daniel

AU - Pinto, Brian L.

AU - Merola, David

AU - Feldman, Leonard

AU - Miller, Redonda

AU - Shermock, Kenneth M

PY - 2017/8/1

Y1 - 2017/8/1

N2 - BACKGROUND: A lack of cost-conscious medication use is a major contributor to excessive healthcare expenditures in the inpatient setting. Expensive medicines are often utilized when there are comparable alternatives available at a lower cost. Increasing prescriber awareness of medication cost at the time of ordering may help promote cost-conscious use of medications in the hospital. OBJECTIVE: To evaluate the impact of cost messaging on the ordering of 9 expensive medications. DESIGN: Retrospective analysis of an institutional cost-transparency initiative. SETTING: A 1145-bed, tertiary care, academic medical center. PARTICIPANTS: Prescribers who ordered medications through the computerized provider order entry system at the Johns Hopkins Hospital. METHODS: Interrupted time series and segmented regression models were used to examine prescriber ordering before and after implementation of cost messaging for 9 highcost medications. RESULTS: Following the implementation of cost messaging, no significant changes were observed in the number of orders or ordering trends for intravenous (IV) formulations of eculizumab, calcitonin, levetiracetam, linezolid, mycophenolate, ribavirin, and levothyroxine. An immediate and sustained reduction in medication utilization was seen in 2 drugs that underwent a policy change during our study, IV pantoprazole and oral voriconazole. IV pantoprazole became restricted at our facility due to a national shortage (-985 orders per 10,000 patient days; P < 0.001), and oral voriconazole was replaced with an alternative antifungal in oncology order sets (–110 orders per 10,000 patient days; P = 0.001). CONCLUSIONS: Prescriber cost transparency alone did not significantly influence medication utilization at our institution. Active strategies to reduce ordering resulted in dramatic reductions in ordering.

AB - BACKGROUND: A lack of cost-conscious medication use is a major contributor to excessive healthcare expenditures in the inpatient setting. Expensive medicines are often utilized when there are comparable alternatives available at a lower cost. Increasing prescriber awareness of medication cost at the time of ordering may help promote cost-conscious use of medications in the hospital. OBJECTIVE: To evaluate the impact of cost messaging on the ordering of 9 expensive medications. DESIGN: Retrospective analysis of an institutional cost-transparency initiative. SETTING: A 1145-bed, tertiary care, academic medical center. PARTICIPANTS: Prescribers who ordered medications through the computerized provider order entry system at the Johns Hopkins Hospital. METHODS: Interrupted time series and segmented regression models were used to examine prescriber ordering before and after implementation of cost messaging for 9 highcost medications. RESULTS: Following the implementation of cost messaging, no significant changes were observed in the number of orders or ordering trends for intravenous (IV) formulations of eculizumab, calcitonin, levetiracetam, linezolid, mycophenolate, ribavirin, and levothyroxine. An immediate and sustained reduction in medication utilization was seen in 2 drugs that underwent a policy change during our study, IV pantoprazole and oral voriconazole. IV pantoprazole became restricted at our facility due to a national shortage (-985 orders per 10,000 patient days; P < 0.001), and oral voriconazole was replaced with an alternative antifungal in oncology order sets (–110 orders per 10,000 patient days; P = 0.001). CONCLUSIONS: Prescriber cost transparency alone did not significantly influence medication utilization at our institution. Active strategies to reduce ordering resulted in dramatic reductions in ordering.

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