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Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital.

Lapointe-Shaw L, Fischer HD, Newman A, John-Baptiste A, Anderson GM, Rochon PA, Bell CM - PLoS ONE (2012)

Bottom Line: The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively.Substituting the least expensive agent could have saved $1.16 million (47%) for PPIs, $162 thousand (17%) for ACE inhibitors and $14 thousand (4%) for ARBs over the year following discharge.In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of Toronto, Toronto, Ontario.

ABSTRACT

Background: Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices.

Methods: We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI), angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) following hospital admission from April 1(st) 2008-March 31(st) 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB) over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class.

Results: The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47%) for PPIs, $162 thousand (17%) for ACE inhibitors and $14 thousand (4%) for ARBs over the year following discharge.

Interpretation: In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.

Show MeSH
First Angiotensin Receptor Blocker Prescription Filled After Hospital Discharge.
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pone-0039737-g003: First Angiotensin Receptor Blocker Prescription Filled After Hospital Discharge.

Mentions: A total 963 patients were initiated on an ARB. Out of a mean 277 ARB days filled per patient, 269 (97%) were for the original discharge agent. During the follow-up year, 4% of patients filled a prescription for an ARB other than the discharge agent. At one year following discharge, 59.5% of living patients were on the original discharge agent. The total cost for filling all ARB prescriptions over the following year was $ 325 Thousand (Table 2). Eprosartan is the least expensive agent at the standard daily dose, yet does not provide as many dose formulations as other ARBs and no patients in our cohort were discharged on this medication. Candesartan was the least expensive option with multiple dosing options (Table 3), and it represented 30% of first prescriptions (Figure 3). The most expensive agent (losartan) cost 9% more than the equivalent dose of candesartan (Table 3). Replacing all ARB prescriptions with the equivalent dose of candesartan would have saved $14 thousand (4%). Supplying ARBs to these patients in hospital would have cost an additional $ 8.5 thousand at a maximum.


Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital.

Lapointe-Shaw L, Fischer HD, Newman A, John-Baptiste A, Anderson GM, Rochon PA, Bell CM - PLoS ONE (2012)

First Angiotensin Receptor Blocker Prescription Filled After Hospital Discharge.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3383681&req=5

pone-0039737-g003: First Angiotensin Receptor Blocker Prescription Filled After Hospital Discharge.
Mentions: A total 963 patients were initiated on an ARB. Out of a mean 277 ARB days filled per patient, 269 (97%) were for the original discharge agent. During the follow-up year, 4% of patients filled a prescription for an ARB other than the discharge agent. At one year following discharge, 59.5% of living patients were on the original discharge agent. The total cost for filling all ARB prescriptions over the following year was $ 325 Thousand (Table 2). Eprosartan is the least expensive agent at the standard daily dose, yet does not provide as many dose formulations as other ARBs and no patients in our cohort were discharged on this medication. Candesartan was the least expensive option with multiple dosing options (Table 3), and it represented 30% of first prescriptions (Figure 3). The most expensive agent (losartan) cost 9% more than the equivalent dose of candesartan (Table 3). Replacing all ARB prescriptions with the equivalent dose of candesartan would have saved $14 thousand (4%). Supplying ARBs to these patients in hospital would have cost an additional $ 8.5 thousand at a maximum.

Bottom Line: The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively.Substituting the least expensive agent could have saved $1.16 million (47%) for PPIs, $162 thousand (17%) for ACE inhibitors and $14 thousand (4%) for ARBs over the year following discharge.In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of Toronto, Toronto, Ontario.

ABSTRACT

Background: Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices.

Methods: We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI), angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) following hospital admission from April 1(st) 2008-March 31(st) 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB) over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class.

Results: The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47%) for PPIs, $162 thousand (17%) for ACE inhibitors and $14 thousand (4%) for ARBs over the year following discharge.

Interpretation: In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.

Show MeSH