Program Schedule

375
Cost of Antimicrobial Therapy Across US Children’s Hospitals

Session: Poster Abstract Session: Pediatric Antimicrobial Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background:   Antimicrobials are among the most commonly used medications for hospitalized children. Antimicrobial stewardship programs (ASPs) have been shown to reduce pharmacy costs through optimization of antimicrobial use. A better understanding of the cost implications of and prescribing patterns for antibiotics may help to target interventions. 

Methods:   We examined antimicrobial cost for hospitalized children using a database of freestanding children's hospitals. We calculated cost and days of therapy (DOT) for all antimicrobials billed to patients discharged from 36 hospitals during 2012.  Standardized cost per patient was compared across hospitals, adjusting for patient demographics and severity of illness and stratifying by condition using APR-DRG codes.

Results:   In 2012, $192 million was spent on antimicrobials at 36 hospitals for 599,518 patients. Antimicrobials were 17% of the total pharmacy budget, ranging from 12% to 34% across hospitals.  Antibacterials accounted for 73% of total antimicrobial cost (Table). Cost per DOT was two times higher for antifungals and antivirals than for antibacterials. Four of the 5 most expensive drugs (cost/DOT) were antifungals. Collectively, vancomycin, meropenem, piperacillin-tazobactam, and amphotericin B-lipid accounted for > 30% of antimicrobial cost. Bone marrow transplant (11%) and cystic fibrosis (7%) had the highest contribution to total antimicrobial cost. We found wide variation in standardized cost across hospitals when isolating children with specific conditions previously identified as important stewardship targets (Figure).

Conclusion: Antimicrobials represent a substantial proportion of medication costs in US children's hospitals, and a few specific drugs account for a large proportion of these costs.  Costs vary widely across centers even after standardizing by patient demographic and clinical characteristics and isolating specific conditions. Exploring the drivers and outcomes of these differences might reveal important targets for antimicrobial stewardship.

Table. Antimicrobial cost and DOT by class

 

Cost (millions)

 

DOT

 

Class

$

%

 

n

%

Cost/DOT

Antibacterials

140

73

 

 2,518,344

82

45

Antifungals

38

20

 

 377,352

12

101

Antivirals

14

7

 

 147,470

5

92

Other

1

1

 

 37,233

1

31

 

193

100

 

 3,080,399

100

63

 

Rachael Ross, MPH, The Children's Hospital of Philadelphia, Philadelphia, PA, Adam L. Hersh, MD, PhD, University of Utah School of Medicine, Salt Lake City, UT, Matthew Kronman, MD, Seattle Children's, Seattle, WA, Jason Newland, MD, Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO and Jeffrey S. Gerber, MD, PhD, Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA

Disclosures:

R. Ross, None

A. L. Hersh, None

M. Kronman, None

J. Newland, Pfizer: Grant Investigator, Grant recipient

J. S. Gerber, None

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