评估特定机构的多非利特起始治疗方案对多非利特起始治疗的平均住院时长和费用的影响。

Evaluation of the Impact of an Institution-Specific Dofetilide Initiation Protocol on Mean Hospital Length of Stay and Cost for Dofetilide Initiation.

作者信息

Kennedy Steven P, Iaizzo Hanna, Fayn Evgueni, Singh Dalip

机构信息

Clement J. Zablocki VA Medical Center, 5000 W. National Ave, Milwaukee, WI, 53295, USA.

Hayat Pharmacy, 1919 W. North Ave, Milwaukee, WI, 53205, USA.

出版信息

Pharmacoecon Open. 2019 Mar;3(1):119-126. doi: 10.1007/s41669-018-0077-0.

DOI:10.1007/s41669-018-0077-0

PMID:29671278

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6393281/

Abstract

BACKGROUND

Dofetilide is a class III antiarrhythmic drug indicated for the conversion and maintenance of normal sinus rhythm in symptomatic patients with atrial fibrillation/atrial flutter. Delay in initiation of dofetilide therapy may increase the duration of hospitalization from two nights to three nights to complete US Food and Drug Administration-required monitoring. Therefore, substantial cost savings may be associated with implementation of an institution-specific dofetilide initiation protocol in order to reduce hospitalization to two nights. This could potentially be achieved through protocol-defined utilization of the option for a condensed dosing interval for the first three doses of dofetilide in order to ensure the administration of two doses on the first day of hospitalization.

OBJECTIVE

The primary objective of this study was to assess the impact of an institution-specific dofetilide initiation protocol on mean hospital length of stay and cost for dofetilide initiation.

METHODS

The study design was a retrospective review of 150 patients admitted to the Clement J. Zablocki Veterans Affairs Medical Center for the purpose of dofetilide initiation. Matching time periods of 18 months before and after implementation of the institution-specific dofetilide initiation protocol were used to randomly select 75 patients from each time period for comparison.

RESULTS

A significant reduction in mean hospital length of stay of 0.56 nights post-implementation of the institution-specific dofetilide initiation protocol was identified (95% confidence interval 0.20-0.92; P = 0.0029). Assuming hospital adjusted expenses per inpatient day of US$1831-2413, a reduction in hospital length of stay of 0.56 nights resulted in estimated cost savings of US$1025-1351 per admission for dofetilide initiation.

CONCLUSION

Implementation of an institution-specific dofetilide initiation protocol decreases mean hospital length of stay and cost for dofetilide initiation.

摘要

背景

多非利特是一种III类抗心律失常药物，用于有症状的心房颤动/心房扑动患者转复和维持正常窦性心律。多非利特治疗开始的延迟可能会使住院时间从两晚增加到三晚，以完成美国食品药品监督管理局要求的监测。因此，实施特定机构的多非利特起始方案以将住院时间缩短至两晚可能会节省大量成本。这有可能通过方案定义的方式来实现，即对多非利特的前三剂采用缩短给药间隔的选项，以确保在住院第一天给予两剂。