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.
S. Won, None
S. K. Wang, None
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