Take a pill (not IV). Save a bundle

JOHNS HOPKINS (US) — Switching hospitalized patients from intravenous to pill forms of the same drugs could safely save millions of dollars a year.

Researchers reviewed computerized patient records for 2010 at the Johns Hopkins Hospital in Baltimore. They estimated that savings of more than $1.1 million could have been realized in the Department of Medicine alone—not including surgical patients—by swapping out four commonly prescribed IV medications with oral equivalents for patients who could take drugs by mouth.

A report on the study is published in the journal Clinical Therapeutics.


“Our study looked at just four drugs administered by one department in one hospital in one year and found more than a million dollars in potential savings,” says Brandyn D. Lau, a medical informatics specialist at Johns Hopkins University and the study’s leader.

“Imagine if every hospital took a hard look at substituting oral medications for IV ones whenever possible. We’re talking about an enormous financial impact, with no risk to patients.”

According to the Centers for Medicare and Medicaid Services, roughly 12 percent of U.S. health care expenditures in 2009—$293.2 billion—were for medications and nondurable medical products.

Lau says a large-scale switch to oral medications has the potential not only to decrease costs, but also to reduce the need for puncturing veins to insert intravenous tubes or medications directly, procedures that carry a risk of hospital-acquired bloodstream infections and longer hospital stays.

Simple reminders to physicians that their patients may be eligible to switch medication types could yield large savings, the researchers say.

The four medications reviewed in the study were chlorothiazide (a medication used to treat high blood pressure and address fluid retention), voriconazole (an anti-fungal drug), levetiracetam (to stop seizures), and pantoprazole (for acid reflux).

By combing Johns Hopkins patient data, Lau’s team examined whether patients receiving those drugs intravenously were also prescribed other medications orally or if they were being fed solid meals, another indication that they would likely have been able to swallow pills.

In 2010, a total of 10,905 doses of the four medications were given by IV to patients admitted through the Department of Medicine. Lau says the drugs are given even more frequently in surgery patients.

The wholesale cost of a 5-milligram tablet of chlorothiazide is $1.48. An equivalent dose of the drug given intravenously is $357.24, more than 200 times as much. Pantoprazole, the most commonly administered medication in the study, is $4.09 per 40-milligram tablet, while a 40-milligram vial is $144. That medication is often given to patients several times a day.

The researchers note that not all patients are able to switch from the IV form to the oral form of a drug. Diet orders may change, Lau says, or a doctor may have a reason for not switching a patient to an oral medication. But even a small conversion of patients from IV to oral medication would have a substantial financial impact.

There are other costs associated with giving medication by IV that could be reduced if fewer drugs were administered that way, Lau says.

The researchers chose these four drugs to study because the oral and IV forms are very similar to one another, but many other drugs potentially could also be swapped out for an even greater cost savings.

To implement the swaps, Lau says hospitals with computerized medication systems could add alerts to their programs that would appear when a patient on an IV medication meets eligibility criteria for oral medication. Lau cautions, however, that doctors are already bombarded with reminders and it might be best to start with drugs with the highest savings per dose, such as levetiracetam and chlorothiazide.

“There is a danger in over-reminding,” Lau says. “Constant reminders may annoy doctors to the point where they stop paying attention. We need to study the best way to get doctors to switch from IV to oral medications.”

Education, he says, is another avenue. Teaching doctors that oral medication is a cheaper alternative to IV may encourage them to make the switch without subjecting them to regular, potentially irritating reminders.

More news from Johns Hopkins University: http://releases.jhu.edu