Swapping pills for certain intravenous medications in hospitals could annually save over $1 million in health care costs per hospital, researchers found. However, getting physicians to make the swap is problematic, experts said.
Multiplied over the entire U.S. hospital system, such a cost saving could make a big dent in the 12 percent of health care expenditures that goes towards the $293.2 billion medications and other non-durable products in 2009, according to the Centers for Medicare and Medicaid Services.
Brandyn Lau, a medical informatics specialist at Johns Hopkins and his colleagues suspected doctors prescribed IVs when the same medications in pill form would be safe and effective.
The group published their findings in the journal Clinical Therapeutics in October.
The group studied four common IV medications for which doctors can safely swap for their oral counterparts - one for fluid build-up, an anti-fungal medicine, an anti-seizure medicine and a medicine for heartburn. The fluid build-up drug costs $1.48 in pill form and $357.24 in its intravenous form.
The study data was generated from the records of 1,410 patients who received 10,905 combined doses of the four drugs in 2010.
Some doctors have a reason for giving IV medicine over the oral form, said Lau in a statement released Oct. 27 by Johns Hopkins, but that's not always the case. The researchers found that substituting the pill form of the heartburn medication would save an average of $680.98 per patient who has to take it in the course of his or her hospital stay.
The researchers suggested adding alerts to computerized ordering systems to remind doctors to think about whether or not a patient really needs an IV. But many hospitals already remind their staff to keep cost savings in mind, and such alerts cannot be tailored in a way that will make them correct in every situation. Adding staff such as hospital pharmacists who have the ability to make customized recommendations for each patient may be a better option, suggests Chris Lehmann, a Johns Hopkins neonatologist and senior author on the study.
There is a danger of over-reminding, Lau said in a statement. Constant reminders to the point where they stop paying attention. We need to study the best way to get doctors to switch from IV to oral medications.
Though swapping pills for IVs when possible is a simple cost saving measure, the challenge is educating doctors and getting them to comply, Lau said.
Lehmann said the reason these changes are difficult to implement is that a doctor's first priority is to the well being of his or her patient. He said the price of medication is the last thing he worries about when a critically ill baby needs treatment.
While this is in the best interest of hospitals, it is not foremost in the mind of the clinician, Lehmann said.