Effect of a multidisciplinary cost-awareness campaign on medication expenditures in an intensive care unit
CCCF ePoster library. Hoi S. Oct 31, 2016; 150919; 40
Sannifer Hoi
Sannifer Hoi
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Topic: Quality Assurance & Improvement

Effect of a multidisciplinary cost-awareness campaign on medication expenditures in an intensive care unit

Hoi, Sannifer1,2; Cahill, Julia3; Howes, Daniel4; Skrobik, Yoanna4,5; Ilan, Roy4,6; Maslove, David4,6; Newman, Paula7

1Dept of Pharmacy, Island Health, Victoria, British Columbia, Canada; 2Dept of Pharmacy Services, Kingston General Hospital, Kingston, Ontario, Canada; 3Dept of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada; 4Dept of Critical Care Medicine, Queen’s University, Kingston, Ontario, Canada; 5Faculty of Medicine, McGill University, Montreal, Quebec, Canada; 6Dept of Medicine, Queen’s University, Kingston, Ontario, Canada; 7North West Telepharmacy Solutions, The North West Company, Winnipeg, Manitoba, Canada.


Introduction: Rising healthcare expenditures have made cost-containment a priority in health care. Medications are a significant driver of hospital expenses, and the intensive care unit (ICU) utilizes costly and large volumes of drugs (1). There is a growing body of literature regarding cost-saving and cost-awareness interventions, however, few studies have been conducted in the ICU (2-4).
Objectives: To evaluate the impact of a multidisciplinary cost-awareness campaign on ICU medication costs.
Methods: In December 2014, a pharmacist-led multidisciplinary steering group initiated a cost-awareness campaign in the medical-surgical ICU at an academic hospital in Kingston, Ontario. The multifaceted intervention involved electronic listings of drug costs, medication discussions at bedside rounds, ongoing audit and feedback reports, and educational posters. Patient information and medication expenditures were collected for 52 weeks pre-intervention and 16 weeks post. Cost data was analyzed using a segmented regression model for interrupted time series. Six months after the initiative, ICU nurses, pharmacists, and physicians were surveyed to assess the perceived benefits of the campaign. 
Results: Patients from the pre- and post-intervention periods had similar demographics and outcomes. The average mean medication cost per patient-day dropped from $117.47 (108.94-126.00) in the pre-intervention period to $98.11 (85.52-110.70) in the post-intervention period (-16.5%). The segmented regression model showed that the campaign was associated with a significant reduction in mean medication expenditure per patient-day (βintervention=-44.79, p=0.0110). When ventilation rate was included in the model, the coefficient and its significance were relatively unchanged (βintervention=-41.81, p=0.0195). No significant change in trend was observed post-intervention (βtrend=1.66, p= 0.3010). Seventy-six percent of surveyed clinicians reported that the campaign improved their medication-cost knowledge.
Conclusion: The multidisciplinary campaign was associated with a significant reduction in cost, and was effective at reducing ICU drug expenditures. Even in a critical care setting, cost-awareness campaigns are effective cost-containment measures.

  1. Weber RJ, Kane SL, Oriolo VA, Saul M, Skledar SJ, Dasta JF. Impact of intensive care unit (ICU) drug use on hospital costs: a descriptive analysis, with recommendations for optimizing ICU pharmacotherapy. Crit Care Med 2003;31:S17–24.       
  2. Anstey MHR, Weinberger SE, Roberts DH. Teaching and practicing cost-awareness in the intensive care unit: A TARTGET to aim for. Journal of Critical Care 2014;29:107-11.
  3. Frazier LM, Brown JT, Divine GW, Fleming GR, Philips NM, Siegal WC, et al. Can physician education lower the cost of prescription drugs? A prospective, controlled trial. Ann Intern Med 1991;115:116–21.
  4. Smith CD, Alliance for Academic Internal Medicine - American College of Physicians High Value, Cost-Conscious Care Curriculum Committee. Teaching high value, cost-conscious care to residents: the Alliance for Academic Internal Medicine - American College of Physicians curriculum. Ann Intern Med 2012;157:284–6.

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