Stenner Shane P, Chakravarthy Rohini, Johnson Kevin B, Miller William L, Olson Julie, Wickizer Marleen, Johnson Nate N, Ohmer Rick, Uskavitch David R, Bernard Gordon R, Neal Erin B, Lehmann Christoph U
Christoph U. Lehmann, MD, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1475, Nashville, TN 37203,
Appl Clin Inform. 2016 Dec 14;7(4):1168-1181. doi: 10.4338/ACI-2016-09-RA-0160.
Spending on pharmaceuticals in the US reached $373.9 billion in 2014. Therapeutic interchange offers potential medication cost savings by replacing a prescribed drug for an equally efficacious therapeutic alternative.
Hard-stop therapeutic interchange recommendation alerts were developed for four medication classes (HMG-CoA reductase inhibitors, serotonin receptor agonists, intranasal steroid sprays, and proton-pump inhibitors) in an electronic prescription-writing tool for outpatient prescriptions. Using prescription data from January 2012 to June 2015, the Compliance Ratio (CR) was calculated by dividing the number of prescriptions with recommended therapeutic interchange medications by the number of prescriptions with non-recommended medications to measure effectiveness. To explore potential cost savings, prescription data and medication costs were analyzed for the 45,000 Vanderbilt Employee Health Plan members.
For all medication classes, significant improvements were demonstrated - the CR improved (proton-pump inhibitors 2.8 to 5.32, nasal steroids 2.44 to 8.16, statins 2.06 to 5.51, and serotonin receptor agonists 0.8 to 1.52). Quarterly savings through the four therapeutic interchange interventions combined exceeded $200,000 with an estimated annual savings for the health plan of $800,000, or more than $17 per member.
A therapeutic interchange clinical decision support tool at the point of prescribing resulted in increased compliance with recommendations for outpatient prescriptions while producing substantial cost savings to the Vanderbilt Employee Health Plan - $17.77 per member per year. Therapeutic interchange rules require rational targeting, appropriate governance, and vigilant content updates.
2014年美国药品支出达3739亿美元。治疗性药物替换通过用同等有效的治疗替代药物替换处方药物，有望节省用药成本。
在门诊处方电子处方书写工具中，针对四类药物（HMG-CoA还原酶抑制剂、血清素受体激动剂、鼻用类固醇喷雾剂和质子泵抑制剂）制定了强制治疗性药物替换推荐警报。利用2012年1月至2015年6月的处方数据，通过将使用推荐治疗性替换药物的处方数量除以使用非推荐药物的处方数量来计算合规率（CR），以衡量有效性。为探究潜在的成本节省情况，对范德比尔特员工健康计划的45000名成员的处方数据和药物成本进行了分析。
对于所有药物类别，均显示出显著改善——合规率有所提高（质子泵抑制剂从2.8提高到5.32，鼻用类固醇从2.44提高到8.16，他汀类药物从2.06提高到5.51，血清素受体激动剂从0.8提高到1.52）。通过四项治疗性药物替换干预措施相结合，每季度节省超过20万美元，估计该健康计划每年节省80万美元，即每位成员节省超过17美元。
在开处方时使用治疗性药物替换临床决策支持工具，提高了门诊处方对推荐的依从性，同时为范德比尔特员工健康计划节省了大量成本——每位成员每年节省17.77美元。治疗性药物替换规则需要合理的目标设定、适当的管理以及对内容的及时更新。
