Prescribing

Reducing costs through in-class therapeutic interchange

Shane P. Stenner, Rohini Chakravarthy, Kevin B. Johnson, William L. Miller, Julie Olson, Marleen Wickizer, Nate N. Johnson, Rick Ohmer, David R. Uskavitch, Gordon R. Bernard, Erin B. Neal, Christoph U. Lehmann

Research output: Contribution to journalArticle

Abstract

Introduction: Spending on pharmaceuticals in the US reached $373.9 billion in 2014. Therapeutic interchange offers potential medication cost savings by replacing a prescribed drug for an equally efficacious therapeutic alternative. Methods: Hard-stop therapeutic interchange recommendation alerts were developed for four medication classes (HMG-CoA reductase inhibitors, serotonin receptor agonists, intranasal steroid sprays, and proton-pump inhibitors) in an electronic prescription-writing tool for outpatient prescriptions. Using prescription data from January 2012 to June 2015, the Compliance Ratio (CR) was calculated by dividing the number of prescriptions with recommended therapeutic interchange medications by the number of prescriptions with non-recommended medications to measure effectiveness. To explore potential cost savings, prescription data and medication costs were analyzed for the 45,000 Vanderbilt Employee Health Plan members. Results: For all medication classes, significant improvements were demonstrated-the CR improved (proton-pump inhibitors 2.8 to 5.32, nasal steroids 2.44 to 8.16, statins 2.06 to 5.51, and serotonin receptor agonists 0.8 to 1.52). Quarterly savings through the four therapeutic interchange interventions combined exceeded $200,000 with an estimated annual savings for the health plan of $800,000, or more than $17 per member. Conclusion: A therapeutic interchange clinical decision support tool at the point of prescribing resulted in increased compliance with recommendations for outpatient prescriptions while producing substantial cost savings to the Vanderbilt Employee Health Plan-$17.77 per member per year. Therapeutic interchange rules require rational targeting, appropriate governance, and vigilant content updates.

Original languageEnglish (US)
Pages (from-to)1168-1181
Number of pages14
JournalApplied Clinical Informatics
Volume7
Issue number4
DOIs
StatePublished - Dec 14 2016
Externally publishedYes

Fingerprint

Interchanges
Prescriptions
Costs and Cost Analysis
Cost Savings
Costs
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Health
Serotonin Receptor Agonists
Proton Pump Inhibitors
Occupational Health
Protons
Therapeutics
Compliance
Pumps
Personnel
Outpatients
Electronic Prescribing
Steroids
Clinical Decision Support Systems
Drug products

Keywords

  • Cost savings
  • Electronic health record
  • Electronic prescribing
  • Therapeutic interchange

ASJC Scopus subject areas

  • Computer Science Applications
  • Health Informatics
  • Health Information Management

Cite this

Stenner, S. P., Chakravarthy, R., Johnson, K. B., Miller, W. L., Olson, J., Wickizer, M., ... Lehmann, C. U. (2016). Prescribing: Reducing costs through in-class therapeutic interchange. Applied Clinical Informatics, 7(4), 1168-1181. https://doi.org/10.4338/ACI-2016-09-RA-0160

Prescribing : Reducing costs through in-class therapeutic interchange. / Stenner, Shane P.; Chakravarthy, Rohini; Johnson, Kevin B.; Miller, William L.; Olson, Julie; Wickizer, Marleen; Johnson, Nate N.; Ohmer, Rick; Uskavitch, David R.; Bernard, Gordon R.; Neal, Erin B.; Lehmann, Christoph U.

In: Applied Clinical Informatics, Vol. 7, No. 4, 14.12.2016, p. 1168-1181.

Research output: Contribution to journalArticle

Stenner, SP, Chakravarthy, R, Johnson, KB, Miller, WL, Olson, J, Wickizer, M, Johnson, NN, Ohmer, R, Uskavitch, DR, Bernard, GR, Neal, EB & Lehmann, CU 2016, 'Prescribing: Reducing costs through in-class therapeutic interchange', Applied Clinical Informatics, vol. 7, no. 4, pp. 1168-1181. https://doi.org/10.4338/ACI-2016-09-RA-0160
Stenner SP, Chakravarthy R, Johnson KB, Miller WL, Olson J, Wickizer M et al. Prescribing: Reducing costs through in-class therapeutic interchange. Applied Clinical Informatics. 2016 Dec 14;7(4):1168-1181. https://doi.org/10.4338/ACI-2016-09-RA-0160
Stenner, Shane P. ; Chakravarthy, Rohini ; Johnson, Kevin B. ; Miller, William L. ; Olson, Julie ; Wickizer, Marleen ; Johnson, Nate N. ; Ohmer, Rick ; Uskavitch, David R. ; Bernard, Gordon R. ; Neal, Erin B. ; Lehmann, Christoph U. / Prescribing : Reducing costs through in-class therapeutic interchange. In: Applied Clinical Informatics. 2016 ; Vol. 7, No. 4. pp. 1168-1181.
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