Background Unnecessary imaging is a potential cost driver in the United States health care system. Objective Using a clinical decision support tool, we determined the percentage of low-utility non-contrast head computed tomography (CT) examinations on emergency patients and calculated the prospective cost implications of providing low-value imaging using time-driven activity-based costing at an academic quaternary pediatric hospital. Materials and methods A clinical decision support tool for imaging, CareSelect (National Decision Support Co., Madison, WI), was integrated in silent mode into the electronic health record from September 2018 through August 2019. Each non-contrast head CT order received a score from the clinical decision support tool based on the American College of Radiology Appropriateness Criteria. Descriptive statistics for all levels of appropriateness scores were compiled with an emphasis on low-utility exams. A micro-costing assessment was conducted using time-driven activity-based costing on head CT without contrast examinations. Results Within the 11-month time period, 3,186 head CT examinations without contrast were ordered for emergency center patients. Among these orders, 28% (896/3,186) were classified as low-utility studies. The base case CT pathway time was 43 min and base case total cost was $193.35. The base case opportunity cost of these low-utility exams extrapolated annually amounts to $188,902 for our institution. Conclusion Silent mode implementation of a clinical decision support tool resulted in 28% of head CT non-contrast exams on emergency patients being graded as low-utility studies. Prospective cost implications resulted in an annual base case cost of $188,902 to Texas Children’s Hospital.
<p class="abstract"><strong>Background:</strong> Antibiotic resistance is a major menace to public health and treatment of several infectious diseases, also associated with an economic burden to society. Pharmacoeconomic analysis of antibiotic usage and cost-minimization analysis provides better and low-cost drug selection for the patients.</p><p class="abstract"><strong>Methods:</strong> The study was conducted as a cross-sectional, observational analysis of restricted antibiotics in the prescriptions (n= 191). Cost minimization analysis was conducted for the restricted antibiotics alone. The drug costs of prescribed brands were compared with the least cost brands, and the percentage cost difference was calculated and compared by student paired ‘t’ test. P<0.05 considered statistical significance. </p><p class="abstract"><strong>Results:</strong> The average age of the patients was found to be 58.1±18.3 (Mean±SD) years, and most of the restricted antibiotics were prescribed for the treatment of hospital-acquired infections 71.7%. Meropenem was prescribed highly 29.8% followed by imipenem (28.8%) and colistin (12%). The major reason for starting restricted antibiotics was found to be infectious diseases (27.7%). The cost-minimization analysis showed that the total unit cost for caspofungin (₹1,85,000 or $2523.40) was found to be higher followed by meropenem (₹1,29,800) in the prescriptions. The mean cost of actually prescribed restricted antibiotics was found to be ₹68,338±61,332 (Mean±SD). The lowest mean cost of restricted antibiotics was found to be ₹32,223±31,082 (p<0.05).</p><p class="abstract"><strong>Conclusions:</strong> Pharmacoeconomic cost-minimization analysis was a useful tool for clinical pharmacist in the selection of appropriate antibiotics and minimizing the burden of the cost of the drugs, it provides a better outcome in patients while using restricted antibiotics with infectious disease.</p>
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