Shah Samarth P, Peters Michael J, Usery Justin B, Twilla Jennifer D
Methodist University Hospital, Memphis, TN, USA.
Hosp Pharm. 2020 Jun;55(3):163-167. doi: 10.1177/0018578719831976. Epub 2019 Feb 21.
Hypercalcemia is a relatively common problem that may require hospital admission based on severity. A treatment option for hypercalcemia is calcitonin given intramuscularly or subcutaneously. In 2015, calcitonin was on our health system formulary, but due to a sharp rise in cost, restrictions were placed to ensure appropriate utilization. These restrictions reserved calcitonin for patients with symptomatic hypercalcemia or severe hypercalcemia, which was defined as an ionized calcium of greater than 1.5 mmol/L and/or total/corrected calcium (Ca) of greater than 13 mg/dL. In addition to providing criteria for its use, calcitonin orders also had an automatic stop date of 24 hours to ensure no more than 2 doses were provided in a 24-hour period. After the initial 24 hours, a patient would have to be reviewed again before any further doses were ordered and administered. If the patient met criteria, an additional 2 doses could be given in the next 24 hours for a total maximum treatment of 4 doses over a 48-hour time frame. An evaluation to assess health system-wide compliance of the usage of calcitonin restrictions regarding utilization, effectiveness, and cost was conducted. In the 2-month study time frame that was examined, there was a decrease in 66 vials of calcitonin that were dispensed. This represents a 43% reduction in usage and an estimated US $450,000 reduction in the total money spent for calcitonin annually. No notable differences in Ca reduction were identified between the groups. This evaluation revealed that putting health system-wide restrictions in use for a high-cost medication can have a major financial impact without compromising clinical efficacy.
高钙血症是一个相对常见的问题，根据严重程度可能需要住院治疗。高钙血症的一种治疗选择是肌内或皮下注射降钙素。2015年，降钙素在我们的医疗系统药品目录中，但由于成本急剧上升，实施了限制措施以确保合理使用。这些限制措施将降钙素保留给有症状的高钙血症或严重高钙血症患者，严重高钙血症定义为离子钙大于1.5 mmol/L和/或总钙/校正钙（Ca）大于13 mg/dL。除了提供使用标准外，降钙素的医嘱还设有24小时的自动停药日期，以确保在24小时内提供不超过2剂药物。在最初的24小时之后，患者在再次订购和使用任何进一步剂量之前必须再次接受评估。如果患者符合标准，可在接下来的24小时内再给予2剂，在48小时的时间范围内总共最多治疗4剂。对降钙素使用限制在整个医疗系统的使用情况、有效性和成本方面的合规性进行了评估。在为期2个月的研究时间范围内，发放的降钙素小瓶数量减少了66瓶。这代表使用量减少了43%，估计每年降钙素的总花费减少了45万美元。两组之间在钙降低方面未发现明显差异。该评估表明，对一种高成本药物在整个医疗系统实施使用限制可产生重大财务影响，而不会损害临床疗效。
