基于证据的医疗机构促红细胞生成素使用管理项目的临床和经济学评价。

Clinical and economic evaluation of an evidence-based institutional epoetin-utilization management program.

机构信息

Department of Pharmacy, Banner Good Samaritan Medical Center, Phoenix, AZ 85006, USA.

出版信息

Clin Ther. 2013 Mar;35(3):294-302. doi: 10.1016/j.clinthera.2013.02.002. Epub 2013 Mar 7.

DOI:10.1016/j.clinthera.2013.02.002

PMID:23465799

Abstract

BACKGROUND

Anemia is common in several patient populations, including those with chronic kidney disease, cancer, and HIV/AIDS, and may require treatment with erythropoietin-stimulating agents (ESAs). Given the potential risks of the ESA, epoetin, and the significant costs associated with this agent, a large teaching medical institution developed a the drug-utilization management program using evidence-based guidelines on appropriate use.

OBJECTIVE

This study was designed to determine the clinical and financial impact of the drug-utilization management program.

METHODS

This retrospective cohort study was conducted at the medical institution that implemented the program using clinical pharmacists. Patients were included if epoetin was administered during their hospital stay (evaluation period, December 1, 2010, to December 31, 2011). The rate of inappropriate epoetin prescribing and the economic impact of guideline implementation were evaluated using comparisons of data from cohorts prescribed epoetin before and after guideline implementation.

RESULTS

Data from 796 patients were included in the analyses (pre-implementation, 496; post-implementation, 300). The proportion of patients prescribed epoetin was significantly smaller after guideline implementation (2.4% vs 1.6%; P < 0.001). The reduction in the total number of epoetin units administered was 45%. The significant reduction (25%) in inappropriate prescribing after guideline implementation was primarily attributed to a 17% decrease in epoetin use in nonspecific anemia. The reduction in inappropriate epoetin prescribing translated into a 23.8% reduction in costs (P < 0.001) associated with inappropriate epoetin use. The estimated annual cost-savings of this program was $198,352 ($16,529/mo).

CONCLUSION

The implementation of a drug-utilization management program using clinical pharmacists who evaluated epoetin was associated with a decrease in inappropriate epoetin prescribing and with significant cost-savings.

摘要

背景

贫血在包括慢性肾脏病、癌症和 HIV/AIDS 在内的多种患者群体中较为常见，可能需要使用促红细胞生成素刺激剂（ESA）进行治疗。鉴于 ESA、促红素的潜在风险以及该药物相关的巨大成本，一所大型教学医疗机构制定了一个基于合理使用证据的药物利用管理计划。

目的

本研究旨在确定药物利用管理计划的临床和经济影响。

方法

本回顾性队列研究在实施该计划的医疗机构中进行，使用临床药师。如果患者在住院期间接受了促红素治疗（评估期为 2010 年 12 月 1 日至 2011 年 12 月 31 日），则将其纳入研究。通过比较实施指南前后使用促红素的患者队列的数据，评估不适当促红素处方的比率和指南实施的经济影响。

结果

共有 796 例患者的数据纳入分析（实施前 496 例，实施后 300 例）。实施指南后，处方促红素的患者比例显著降低（2.4%比 1.6%；P < 0.001）。给予的促红素单位总数减少了 45%。实施指南后不适当处方显著减少（25%），主要归因于非特异性贫血中促红素使用减少了 17%。不适当使用促红素导致的处方减少转化为与不适当使用促红素相关的成本降低了 23.8%（P < 0.001）。该计划的年估计节省成本为 198352 美元（每月 16529 美元）。