Vancomycin abuse contributes to drug costs
Overuse costs more than just resistance
Inappropriate use of vancomycin is known to contribute to increased prevalence of resistant pathogens, but it also may contribute to spiraling costs in hospital pharmaceutical budgets, according to a new study.1
Overall pharmaceutical costs, which approach $40 billion annually, account for about 8% of health care costs. Prescription drugs represent 5% to 20% of the total hospital budget, and antimicrobials account for 20% to 50% of hospital pharmaceutical costs. Some investigators estimate the worldwide market for pharmaceuticals will continue to increase, the author reports. Costs were estimated at $75 billion in 1980 and $150 billion in 1990, and they are expected to be $270 billion by the year 2000.
Studies also show vancomycin use is increasing, and dosing often is inappropriate. Because of the emergence of multidrug-resistant coagulase-positive or -negative Staphylococcus, Enterococcus, and Streptococcus pneumoniae, vancomycin use has dramatically increased during the last several years in the United States. In addition, one study found that of 101 orders, vancomycin use was in compliance with the CDC recommendations in only 35 instances. Oncology, neurosurgery, and cardiovascular surgery patients are particularly more likely to receive vancomycin inappropriately.
The few studies that have assessed the cost of vancomycin use indicate that it is expensive, the author reports. A prospective cohort study performed at a community hospital reported that 100 infected adults received almost 1,400 doses of vancomycin. Duration of therapy (at a dosage of 2,000 mg/d) lasted a mean of 10 days. Phlebitis was the most common adverse reaction, occurring in 38 patients.
The investigators considered various costs, including pharmacy preparation, drug administration by nurses, monitoring serum concentrations, and, most important, treating adverse reactions. They found the overall cost for preparation and administration was nearly $24,000 (mean, $17.50 per dose), and the cost for monitoring serum concentrations was about $1,700 (mean, $15 per assay). Finally, the cost for treatment of adverse reactions was about $4,700 (mean, about $94 per adverse reaction). Thus, the total cost was about $30,000.
"The appropriateness of antimicrobial use, including vancomycin, needs to be assessed in our hospitals, in health maintenance organizations, in outpatient settings, and in home therapy," the study concludes. "Pharmacy databases, particularly in the inpatient setting, should be developed and used for monitoring antimicrobial use, not just for billing."
Reference
1. Jarvis WR. Epidemiology, appropriateness, and cost of vancomycin use. Clin Infect Dis 1998; 26:1,200-1,203.
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