Economic impact of pharmaceutical interventions in a medium complexity Brazilian university hospital

Carneiro, Leandro Gouveia; Paz, Karine Dal; Ribeiro, Eliane

doi:10.1590/s2175-97902022e201198

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Brazilian Journal of Pharmaceutical Sciences

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Article • Braz. J. Pharm. Sci. 58 • 2022 • https://doi.org/10.1590/s2175-97902022e201198 copy

Economic impact of pharmaceutical interventions in a medium complexity Brazilian university hospital

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Clinical pharmacists have been increasing their participation mainly through actions aimed at patient care, with international studies demonstrating favorable cost-benefit ratio from pharmacists interventions. However, there are few studies carried out in Brazil about the subject. This study aims to assess the economic impact of pharmaceutical interventions (PIs) in a hospital setting performed in October 2018. Each performed PI was registered and associated with the direct cost of drugs for economic impact analysis. A total of 185 PIs were evaluated, comprising 106 patients. The most intervened drugs were antibiotics, presenting the greatest economic impact, R$2,370. The total economic impact was R$2,578, mainly in the Pediatric Intensive Care Unit that represented R$1,701. Regarding the economic impact by PI as the “Suspension of drug without indication” saved R$1,360 while the “Inclusion of required drugs” cost R$807. It was estimated that the savings would be R$30,936 and, if PIs were performed at day zero, the savings would be R$79,728 per year. An average of 1.75 PI per patient was performed with an economic impact of R$14 per PI. Our results showed that clinical pharmacist’s role in the evaluation of pharmacotherapy is important for patients’ health and represents a positive economic impact.

Keywords:
Pharmaceutical intervention; Direct costs; Economic impact; Hospital setting

CATEGORY	PHARMACEUTICAL INTERVENTION
Dosage	Correction of dosage - reconciliation
	Correction for rounding dose
	Correction of subdose
	Correction of overdose
	Correction of exceeded maximum daily dose
	Renal/hepatic dosage adjustment
	Correction of administration frequency
	Sequential therapy (intravenous to oral)
Presentation	Drug presentation - substitution
Interaction	Drug interaction detected
Safety	Item forgotten to be suspended
	Item forgotten to be prescribed
	Renal function lab test request
	Drug dosing
	Vancomycin adjustment by PK/PD
Requirement	Suspension of drug without indication
	Drug substitution
	Inclusion of required drug
	Non-standard drugs - substitution/suspension
	Adjustment to therapy protocol
Parenteral nutrition	PN - item inclusion on prescription
	PN - item suspended (not suitable for treatment)
	PN - substitution of item
	PN - final volume correction
	PN - composition correction
	PN - dosage correction
	PN - osmolarity correction

Drug class	Number of PIs	Real economic impact (R$)	Estimated economic impact (R$)
Antibiotics	49	2,370	6,515
Anticoagulants	18	-290	-602
Antacids	17	-55	-38
Anti-inflammatories	17	294	432
Non-opioids analgesics	10	-56	-61
Antihypertensives	09	23	22
Antiemetics	08	117	139
Others	57	177	237
TOTAL	185	2,578	6,644

Pharmaceutical Intervention	Quantity	Total treatment cost (R$)				Real economic impact (R$)	Average of real economic impact (R$)	Estimated economic impact (R$)
		With PI		PI since first therapy day
		Total	By PI	Total	By PI
Inclusion of required drug	30	0	0	807	27	-807	-27	-807
Correction of subdose	19	1,592	84	2,805	148	-592	-31	-1,213
Renal/hepatic dosage adjustment	6	498	83	546	91	-108	-18	-48
Item forgotten to be prescribed	9	451	50	411	46	-29	-3	40
Correction of dosage - reconciliation	1	1	1	1	1	0	0	0
Sequential therapy (intravenous to oral)	2	23	11	7	4	6	3	16
Correction for rounding dose	8	309	39	172	22	51	6	137
Drug presentation - substitution	2	168	84	51	26	108	54	117
Non-standard drugs - substitution/suspension	5	175	35	252	50	160	32	-77
Item forgotten to be suspended	4	297	74	0	0	192	48	297
Correction of administration frequency	22	1,454	66	1,280	58	255	12	174
Correction of overdose	24	2,133	89	937	39	467	19	1,196
Drug substitution	13	1,961	151	1,193	92	562	43	768
Correction of exceeded maximum daily dose	5	1,925	385	953	191	953	191	972
Suspension of drug without indication	35	5,072	145	0	0	1,360	39	5,072
*Subtotal - negative economic impacts*	-	-	-	-	-	-1536	-	-2145
*Subtotal - positive economic impacts*	-	-	-	-	-	4114	-	8789
TOTAL	185	16,059	87	9,415	51	2,578	14	6,644
TOTAL estimated impact annually	2220	192,798	87	112,980	51	30,956	14	79,728

Inpatient care unit	Number of PIs						Number of patients						Total cost (R$)		Real economic impact (R$)	Average real economic impact by PI (R$)	Average real economic impact per patient (R$)	Estimated economic impact (R$)
	Total	Gender				Age average (years old)	Total	Gender				Age average (years old)
		F		M				F		M			Without PI	PI since first therapy day
		#	%	#	%			#	%	#	%		Without PI	PI since first therapy day
Nursery	4	1	25	3	75	0.03	3	1	33	2	67	0.03	271	298	-2	-1	-1	-27
Surgical	65	17	26	48	74	52	33	13	39	20	61	54	3,142	2,704	129	2	4	438
Adult General	33	14	42	18	55	63	22	11	50	11	50	60	1,711	1,776	25	1	1	-65
Pediatric General	32	13	41	19	59	3.6	19	8	42	11	58	3.9	1,506	856	300	9	16	650
Women's Health	2	2	100	0	0	25	2	2	100	0	0	25	4	4	0	0	0	0
Adult ICU	27	14	52	13	48	60	17	11	65	6	35	60	3,016	2,264	279	10	16	751
Neonatal ICU	5	5	100	0	0	0.1	3	3	100	0	0	0.1	301	93	146	29	49	208
Pediatric ICU	17	8	47	9	53	4	7	4	57	3	43	4.8	6,108	1,420	1,701	100	243	4,689
TOTAL	185	74	40	110	60	-	106	53	50	53	50	-	16,059	9,415	2,578	14	24	6,644
TOTAL estimated impact annually	2,220	888	40	1,320	60	-	1,272	636	50	636	50	-	192,798	112,980	30,935	14	24	79,728

Universidade de São Paulo, Faculdade de Ciências Farmacêuticas Av. Prof. Lineu Prestes, n. 580, 05508-000 S. Paulo/SP Brasil, Tel.: (55 11) 3091-3824 - São Paulo - SP - Brazil
E-mail: bjps@usp.br

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[1] *Correspondence: L. G. Carneiro. Faculdade de Ciências Farmacêuticas. Universidade de São Paulo, São Paulo, Brasil. Avenida Professor Lineu Prestes, 580, bloco 13A, Cidade Universitária, São Paulo - SP. CEP 05508-000. E-mail: leandrogcarneiro@gmail.com.