Use and costs of inhaled nitric oxide and inhaled epoprostenol in adult critically ill patients: A quality improvement project

Stephanie L. Davis, Jessica R. Crow, John R. Fan, Katie Mattare, Glenn Whitman, Roy G Brower, Annette Rowden, Aliaksei Pustavoitau

Research output: Contribution to journalArticle

Abstract

Purpose: Inhaled epoprostenol and inhaled nitric oxide are pulmonary vasodilators commonly used in the management of acute respiratory distress syndrome and right ventricular failure; however, they have vastly different cost profiles. The purpose of the project was to transition from nitric oxide to epoprostenol as the inhaled pulmonary vasodilator (IPV) of choice in adult critically ill patients and evaluate the effect of the transition on associated usage and costs. Methods: A single-center, prospective, before and after quality improvement project including adult patients receiving inhaled nitric oxide, inhaled epoprostenol, or both was conducted in 7 adult intensive care units, operating rooms, and postanesthesia care units of a tertiary care academic medical center. The total number of patients, hours of therapy, and costs for each agent were compared between stages of protocol implementation and annually. Results: Seven hundred twenty-nine patients received inhaled nitric oxide, inhaled epoprostenol, or both during the study period. The monthly inhaled nitric oxide use in number of patients, hours, and cost decreased during all stages of the project (p < 0.01). The monthly inhaled epoprostenol use in number of patients, hours, and cost increased during all stages (p < 0.01). Overall, total IPV use increased during the study. However, despite this increase in usage, there was a 47% reduction in total IPV cost. Conclusion: Implementation of a staged protocol to introduce and expand inhaled epoprostenol use in adult critically ill patients resulted in decreased use and cost of inhaled nitric oxide. The total cost of all IPV was decreased by 47% despite increased IPV use.

Original languageEnglish (US)
Pages (from-to)1413-1419
Number of pages7
JournalAmerican Journal of Health-System Pharmacy
Volume76
Issue number18
DOIs
StatePublished - Sep 3 2019

Fingerprint

Epoprostenol
Quality Improvement
Critical Illness
Nitric Oxide
Vasodilator Agents
Costs and Cost Analysis
Lung
Adult Respiratory Distress Syndrome
Tertiary Healthcare
Operating Rooms
Intensive Care Units

Keywords

  • cost savings
  • epoprostenol
  • nitric oxide
  • pulmonary hypertension
  • right ventricular dysfunction
  • vasodilator agents

ASJC Scopus subject areas

  • Pharmacology
  • Health Policy

Cite this

Use and costs of inhaled nitric oxide and inhaled epoprostenol in adult critically ill patients : A quality improvement project. / Davis, Stephanie L.; Crow, Jessica R.; Fan, John R.; Mattare, Katie; Whitman, Glenn; Brower, Roy G; Rowden, Annette; Pustavoitau, Aliaksei.

In: American Journal of Health-System Pharmacy, Vol. 76, No. 18, 03.09.2019, p. 1413-1419.

Research output: Contribution to journalArticle

@article{1507f60736ca4c27bfe1434606c853a5,
title = "Use and costs of inhaled nitric oxide and inhaled epoprostenol in adult critically ill patients: A quality improvement project",
abstract = "Purpose: Inhaled epoprostenol and inhaled nitric oxide are pulmonary vasodilators commonly used in the management of acute respiratory distress syndrome and right ventricular failure; however, they have vastly different cost profiles. The purpose of the project was to transition from nitric oxide to epoprostenol as the inhaled pulmonary vasodilator (IPV) of choice in adult critically ill patients and evaluate the effect of the transition on associated usage and costs. Methods: A single-center, prospective, before and after quality improvement project including adult patients receiving inhaled nitric oxide, inhaled epoprostenol, or both was conducted in 7 adult intensive care units, operating rooms, and postanesthesia care units of a tertiary care academic medical center. The total number of patients, hours of therapy, and costs for each agent were compared between stages of protocol implementation and annually. Results: Seven hundred twenty-nine patients received inhaled nitric oxide, inhaled epoprostenol, or both during the study period. The monthly inhaled nitric oxide use in number of patients, hours, and cost decreased during all stages of the project (p < 0.01). The monthly inhaled epoprostenol use in number of patients, hours, and cost increased during all stages (p < 0.01). Overall, total IPV use increased during the study. However, despite this increase in usage, there was a 47{\%} reduction in total IPV cost. Conclusion: Implementation of a staged protocol to introduce and expand inhaled epoprostenol use in adult critically ill patients resulted in decreased use and cost of inhaled nitric oxide. The total cost of all IPV was decreased by 47{\%} despite increased IPV use.",
keywords = "cost savings, epoprostenol, nitric oxide, pulmonary hypertension, right ventricular dysfunction, vasodilator agents",
author = "Davis, {Stephanie L.} and Crow, {Jessica R.} and Fan, {John R.} and Katie Mattare and Glenn Whitman and Brower, {Roy G} and Annette Rowden and Aliaksei Pustavoitau",
year = "2019",
month = "9",
day = "3",
doi = "10.1093/ajhp/zxz151",
language = "English (US)",
volume = "76",
pages = "1413--1419",
journal = "American Journal of Health-System Pharmacy",
issn = "1079-2082",
publisher = "American Society of Health-Systems Pharmacy",
number = "18",

}

TY - JOUR

T1 - Use and costs of inhaled nitric oxide and inhaled epoprostenol in adult critically ill patients

T2 - A quality improvement project

AU - Davis, Stephanie L.

AU - Crow, Jessica R.

AU - Fan, John R.

AU - Mattare, Katie

AU - Whitman, Glenn

AU - Brower, Roy G

AU - Rowden, Annette

AU - Pustavoitau, Aliaksei

PY - 2019/9/3

Y1 - 2019/9/3

N2 - Purpose: Inhaled epoprostenol and inhaled nitric oxide are pulmonary vasodilators commonly used in the management of acute respiratory distress syndrome and right ventricular failure; however, they have vastly different cost profiles. The purpose of the project was to transition from nitric oxide to epoprostenol as the inhaled pulmonary vasodilator (IPV) of choice in adult critically ill patients and evaluate the effect of the transition on associated usage and costs. Methods: A single-center, prospective, before and after quality improvement project including adult patients receiving inhaled nitric oxide, inhaled epoprostenol, or both was conducted in 7 adult intensive care units, operating rooms, and postanesthesia care units of a tertiary care academic medical center. The total number of patients, hours of therapy, and costs for each agent were compared between stages of protocol implementation and annually. Results: Seven hundred twenty-nine patients received inhaled nitric oxide, inhaled epoprostenol, or both during the study period. The monthly inhaled nitric oxide use in number of patients, hours, and cost decreased during all stages of the project (p < 0.01). The monthly inhaled epoprostenol use in number of patients, hours, and cost increased during all stages (p < 0.01). Overall, total IPV use increased during the study. However, despite this increase in usage, there was a 47% reduction in total IPV cost. Conclusion: Implementation of a staged protocol to introduce and expand inhaled epoprostenol use in adult critically ill patients resulted in decreased use and cost of inhaled nitric oxide. The total cost of all IPV was decreased by 47% despite increased IPV use.

AB - Purpose: Inhaled epoprostenol and inhaled nitric oxide are pulmonary vasodilators commonly used in the management of acute respiratory distress syndrome and right ventricular failure; however, they have vastly different cost profiles. The purpose of the project was to transition from nitric oxide to epoprostenol as the inhaled pulmonary vasodilator (IPV) of choice in adult critically ill patients and evaluate the effect of the transition on associated usage and costs. Methods: A single-center, prospective, before and after quality improvement project including adult patients receiving inhaled nitric oxide, inhaled epoprostenol, or both was conducted in 7 adult intensive care units, operating rooms, and postanesthesia care units of a tertiary care academic medical center. The total number of patients, hours of therapy, and costs for each agent were compared between stages of protocol implementation and annually. Results: Seven hundred twenty-nine patients received inhaled nitric oxide, inhaled epoprostenol, or both during the study period. The monthly inhaled nitric oxide use in number of patients, hours, and cost decreased during all stages of the project (p < 0.01). The monthly inhaled epoprostenol use in number of patients, hours, and cost increased during all stages (p < 0.01). Overall, total IPV use increased during the study. However, despite this increase in usage, there was a 47% reduction in total IPV cost. Conclusion: Implementation of a staged protocol to introduce and expand inhaled epoprostenol use in adult critically ill patients resulted in decreased use and cost of inhaled nitric oxide. The total cost of all IPV was decreased by 47% despite increased IPV use.

KW - cost savings

KW - epoprostenol

KW - nitric oxide

KW - pulmonary hypertension

KW - right ventricular dysfunction

KW - vasodilator agents

UR - http://www.scopus.com/inward/record.url?scp=85072058729&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072058729&partnerID=8YFLogxK

U2 - 10.1093/ajhp/zxz151

DO - 10.1093/ajhp/zxz151

M3 - Article

C2 - 31372630

AN - SCOPUS:85072058729

VL - 76

SP - 1413

EP - 1419

JO - American Journal of Health-System Pharmacy

JF - American Journal of Health-System Pharmacy

SN - 1079-2082

IS - 18

ER -