Pharmacoeconomics: therapeutic and economic considerations in treating the critically ill patient.

The critically ill patient is at high risk for developing complications and, consequently, higher costs of treatment. Because of the high costs associated with these patients, healthcare payers are demanding the development of criteria to ensure cost-effective care. Pharmacists can play an important role in ensuring cost-effective and appropriate care of critically ill patients. The length of hospital stay, the single most important variable influencing the overall cost of patient care, is increased by lack of a structured patient management plan and by the development of complications. Many of these complications are preventable by appropriate drug therapy and monitoring, thus representing the cost factor most controllable by pharmacists. Pharmacists can use newer tools such as cost-effective analysis and clinical decision analysis to identify and utilize drug therapies that result in decreased complications and decreased length of hospital stay, as measured by decreased costs. Equally important is the development of criteria for the appropriate use of drug therapies. Pharmacists must take an active role in working with physicians, nurses, payers, and risk managers.