224. Cost Analysis of a Significant Decrease in Vancomycin Use as a Result of an Antimicrobial Stewardship Intervention
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions to Improve Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
  • Hodgson Vancomycin Analysis.pdf (1.1 MB)
  • Background: A previous pre-post quasi-experimental study performed at an academic medical center assessed benefits of daily stewardship review with and without rapid diagnostic technology (RDT). The study found no difference in time to effective antibiotic therapy when comparing daily stewardship review to RDT and historical control groups. However, vancomycin duration of therapy significantly decreased with daily stewardship review compared to control (31.8 vs. 66 hours, p<0.001). Subsequent elimination of this RDT saved the institution $53,000 in annual costs. However, the effect of the decrease in vancomycin use on this institution's annual costs is unknown.

    Methods: The purpose of the present study is to determine the difference in institutional costs associated with vancomycin after implementation of a stewardship intervention. A retrospective cost analysis was performed which included hospitalized adults on vancomcyin for positive blood cultures from June-October 2014 (pre-intervention) and June-October 2015 (post-intervention). The primary outcome was the amount of institutional cost saved, including drug, phlebotomy, laboratory, nursing, and pharmacy costs. Secondary outcomes included vancomycin DOT/1,000 patient days, nephrotoxicity, in-hospital mortality, and length of stay.

    Results: Institutional cost savings associated with vancomycin over five months amounted to $2,900 for an extrapolated cost savings of $6,960 per year. Although this cost savings was minimal, there were decreases in each individual vancomycin cost component. Drug acquisition was associated with the largest cost reduction represented by a 26% decline. Next, phlebotomy and laboratory costs each decreased by 24%, while nursing and pharmacy costs decreased by 7% and 4%, respectively. There were no differences in vancomycin DOT/1,000 patient days, nephrotoxicity, in-hospital mortality, or length of stay.

    Conclusion: Vancomycin is associated with many hidden ancillary costs, and pharmacy and nursing labor remain substantial despite reduction in its use. The tracking of antimicrobial stewardship actions is highly recommended; however, more research is needed to determine the optimal process for a vancomycin cost analysis.

    Hayley Hodgson, PharmD1, Paul O'Donnell, PharmD1, Sarah Won, MD, MPH2 and Sheila K. Wang, PharmD, BCPS1, (1)Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, (2)Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, IL


    H. Hodgson, None

    P. O'Donnell, None

    S. Won, None

    S. K. Wang, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.