Foulke G E, Siepler J
Division of Pulmonary/Critical Care Medicine, University of California Davis Medical Center, Sacramento.
J Clin Gastroenterol. 1990;12 Suppl 2:S64-8.
The purpose of formulary management is to contain costs while preserving quality care. A pharmacy cost review can identify key areas where limiting the agents used could lower costs. H2-receptor antagonists represent such agents. At UC Davis Medical Center, H2-receptor antagonists were found to be one of the highest-cost drug groups in the hospital. Seventy percent of H2-receptor antagonist use was for intravenous prophylaxis of stress ulcer. After a committee review of available data, H2-receptor antagonists were considered therapeutically equivalent. Cimetidine was chosen as the primary H2-receptor antagonist because of an estimated 36% cost savings. Inpatient H2-receptor antagonist use changed from 90% ranitidine prior to the decision to 90% cimetidine after the decision. A monitoring program revealed that there were similar numbers of elevated drug levels for theophylline, phenytoin, and lidocaine before and after the programmatic change. There was no difference in numbers of patients with theophylline toxicity on cimetidine or ranitidine. The incidence of bleeding from stress ulcer was 1.4% in the year following the change to cimetidine use. With aggressive review and utilization of scientific data, cost-saving H2-receptor antagonist restriction decisions can be made that do not compromise quality care.
处方集管理的目的是在保证医疗质量的同时控制成本。药房成本审查可以确定限制使用某些药物可降低成本的关键领域。H2受体拮抗剂就是这类药物。在加州大学戴维斯分校医疗中心，H2受体拮抗剂被发现是医院中成本最高的药物类别之一。70%的H2受体拮抗剂用于静脉预防应激性溃疡。在委员会对现有数据进行审查后，H2受体拮抗剂被认为在治疗上等效。由于预计可节省36%的成本，西咪替丁被选为主要的H2受体拮抗剂。住院患者使用H2受体拮抗剂的情况从决定前90%使用雷尼替丁变为决定后90%使用西咪替丁。一项监测计划显示，在方案变更前后，茶碱、苯妥英和利多卡因的药物水平升高的数量相似。使用西咪替丁或雷尼替丁的患者中，茶碱中毒的人数没有差异。改用西咪替丁后的一年中，应激性溃疡出血的发生率为1.4%。通过积极审查和利用科学数据，可以做出节省成本的H2受体拮抗剂限制决定，而不会影响医疗质量。
