A randomized trial of the effects of pharmacist intervention on the cost of antiemetic therapy with ondansetron.

Ondansetron has had a major impact on the prevention of emesis in patients receiving chemotherapy. However, the high cost and potential for inappropriate prescribing of this agent warranted a closer examination of its utilization. Hospital guidelines regarding the use of ondansetron were prepared by the Pharmacy and Therapeutics Committee and approved by the Medical Advisory Committee. The guidelines were then distributed to all physicians. Physicians were randomized into an intervention or non-intervention group. A prospective drug use evaluation was then conducted for a 10-week period where pharmacists monitored ondansetron prescribing and compared each order against hospital guidelines. For orders deemed inappropriate, only the intervention-group physicians were contacted for therapy modification. The control of nausea and vomiting was then assessed for all patients 24 h and 72 h after chemotherapy via a simple patient questionnaire. There were no significant differences with respect to the control of nausea and vomiting between patients who received ondansetron according to guidelines and those who did not. A total of 76% (48/63) of the prescriptions met hospital guidelines in the intervention group compared to 51.6% (33/64) in the control (P = 0.007). During the study period, physicians in the intervention group prescribed $Can 757 worth of ondansetron inappropriately compared to $1814 in the control. Drug use evaluation with pharmacist intervention was an effective method of controlling unnecessary hospital costs and contributed towards the appropriate use of ondansetron without compromising patient care.