BackgroundDirect oral anticoagulants (DOAC) are widely used in patients with atrial fibrillation. However, inappropriate use is prevalent, and this potentially increases the risk of thromboembolic and haemorrhagic events. These events also imply an important economic burden. In our institution, a clinical pharmacist is dedicated to performing medication review for all DOAC patients.PurposeTo determine the net cost avoidance of pharmaceutical interventions on the DOAC prescription.Material and methodsWe constructed a decision tree model, using a public payer perspective. We included hospitalised medical patients taking a DOAC. The appropriateness of the prescription was assessed using nine items of the Medication Appropriatenes Index1. The theoretical thromboembolic and haemorrhagic risks of patients under DOAC were collected from the literature. Evaluation of the individual potential risks was based on the Nesbit risk assignment conducted by two independent clinical pharmacists2. Based on diagnosis related group coding and literature data, different costs were included: institutional disease costs of complications, annualised ambulatory stroke costs, drugs costs and pharmacist costs. In the reference case we did not add consultancy fees for the pharmacist. A univariate sensitivity analysis was performed to evaluate the robustness of our results and key assumptions.Results75 patients met the inclusion criteria. 36 (48%) had an inappropriate DOAC prescription. The net cost benefit analysis showed that the saved difference between avoided costs (7954€) and annualised medication costs and pharmacist costs (4 323€) was 3631€ for 75 patients. The univariate sensitivity analysis enlightened a net cost benefit if the prevalence of inappropriate prescribing and disease costs decreased to 28% and 45%, respectively.ConclusionBesides enhancement of the prescription’s quality by the clinical pharmacist, our results provide evidence that this intervention brings positive economic benefits.A complete economic analysis should be considered to demonstrate the cost effectiveness of a clinical pharmacist.References and/or AcknowledgementsLarock AS, et al. Appropriateness of prescribing dabigatran etexilate and rivaroxaban in patients with nonvalvular atrial fibrillation: a prospective study, Ann Pharmacother 2014;48:1258Nesbit, et al. Implementation and pharmacoeconomic analysis of a clinical staff pharmacist practice model, Am J Health Syst Pharm 2001;58:784No conflict of interest.
BackgroundPatients in the intensive care unit (ICU) are at risk of medication errors (polypharmacy, critical nature of their illnesses and use of high-risk drugs). Collaboration with a clinical pharmacist can be helpful in minimising these risks. In order to develop and sustain clinical pharmacy activity in the ICU at our hospital, formal evaluation of the potential benefit was required.PurposeTo describe the characteristics of interventions performed by an ICU clinical pharmacist, including their clinical relevance and likelihood of preventing adverse drug events (ADEs), as well as carrying out a cost analysis on a subgroup of critical interventions.Material and methodsA prospective interventional study was conducted in the cardiac and cardio-surgical ICU of a university teaching hospital. The clinical pharmacist provided pharmaceutical care to cardiovascular surgical and acute coronary syndrome ICU patients over a 9 week period.All clinical pharmacy interventions (CPIs) were recorded and evaluated by two independent evaluators for clinical relevance and likelihood of preventing ADEs. The CPIs were categorised in a risk classification system adapted from the Society of Hospital Pharmacists of Australia.For the cost analysis, we relied on German adverse drug events micro-costing data by Rottenkolber et al.ResultsA total of 230 CPIs were performed in 58 patients. The acceptance rate was 85.5%. The medication classes most frequently involved were: blood and coagulation (16.9%), cardiovascular system (14.8%), pain and fever drugs (14.8%). Sixty-six (33.8%) interventions were considered high/extreme risk, and anticoagulants and antiplatelet agents alone accounted for 25.8% of those.The cut-off to cover the salary of the clinical pharmacist could be reached, if 24 severe adverse events on anticoagulants and antiplatelet agents were avoided per 7 weeks.Two-thirds of all CPIs required the presence of the pharmacist in the unit. Analysis of the medical record (45.1%) and contact with a primary care provider (46.7%) were proportionally the sources of information most often used in the case of high/extreme CPIs.ConclusionThis study provides data that supports the expansion of clinical pharmacy services to cardiovascular surgical patients in the ICU.Reference and/or Acknowledgements1. Rottenkolber D, et al. Costs of adverse drug events in German hospitals – a microcosting study. Value Health2012Sep–Oct;15(6):868–875.No conflict of interest
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