Impact of pharmacist’s interventions on cost of drug therapy in intensive care unit

UNLABELLED Pharmacist participation in patient care team has been shown to reduce incidence of adverse drug events, and overall drug costs. However, impact of pharmacist participation in the multidisciplinary intensive care team on cost saving and cost avoidance has little been studied in Thailand. OBJECTIVE To describe the characteristics of the interventions and to determine pharmacist's interventions led to change in cost saving and cost avoidance in intensive care unit (ICU). METHODS A Prospective, standard care-controlled study design was used to compare cost saving and cost avoidance of patients receiving care from patient care team (including a clinical pharmacist) versus standard care (no pharmacist on team). All patients admitted to the medical intensive care unit 1 and 2 during the same period were included in the study. The outcome measures were overall drug cost and length of ICU stay. Interventions made by the pharmacist in the study group were documented. The analyses of acceptance and cost saving and/or cost avoidance were also performed. RESULTS A total of 65 patients were admitted to either ICU 1 or 2 during the 5 week-study period. The pharmacist participated in patient care and made total of 127 interventions for the ICU-1 team. Ninety-eight percent of the interventions were accepted and implemented by physicians. The difference of overall drug cost per patient between two groups was 182.01 USD (1,076.37 USD in study group and 1,258.38 USD in control group, p=0.138). The average length of ICU stay for the intervention group and the control group was not significantly different (7.16 days vs. 6.18 days, p=0.995). The 125 accepted interventions were evaluated for cost saving and cost avoidance. Pharmacist's interventions yielded a total of 1,971.43 USD from drug cost saving and 294.62 USD from adverse drug event cost avoidance. The net cost saved and avoided from pharmacist interventions was 2,266.05 USD. Interventions involving antibiotic use accounted for the largest economic impact (1,958.61 USD). CONCLUSIONS Although the statistical was not significant, having a pharmacist participated in ICU patient care team tend to reduced overall drug cost, cost saving, and cost avoidance. The largest cost impact and intervention requirement involved antibiotic use.