Following massive price hikes in a pair of heart drugs, the Cleveland Clinic implemented a strategy that saved an estimated $8.5 million over two years.
By eliminating wasteful ordering and finding therapeutic alternatives, a multidisciplinary team dramatically decreased the use of nitroprusside and isoproterenol. Nitroprusside’s cost per 50 milligrams increased thirtyfold from 2012 to 2015—from $27.46 to $880.88. The per-milligram price of isoproterenol skyrocketed from $26.20 to $1,790.11 during that same timeframe.
The challenge in replacing those drugs, according to Cleveland Clinic cardiologist Umesh N. Khot, is no generic or therapeutic substitution options are available. But Khot and two colleagues detailed their cost-saving measures in a NEJM Catalyst paper, offering steps for other hospitals to follow suit.
First, they analyzed common indications for the use of both drugs and considered alternatives. No alternatives were found for the use of nitroprusside in treating acute heart failure, and no alternatives were found for isoproterenol in electrophysiology testing. Therefore, the drugs continued to be used in those cases.
However, Cleveland Clinic began replacing nitroprusside with nitroglycerin for hypertension management following cardiac surgery and with clevidipine for the treatment of aortic dissection. Dobutamine was used as an alternative to isoproterenol for intraoperative testing of myectomy patients.
In addition, the team adjusted medication ordering options to cut the quantity of nitroprusside and isoproterenol delivered in certain order sets.
When combined, these measures yielded an absolute cost savings of $8,067,551 and a relative cost savings of 56 percent for nitroprusside and an absolute cost savings of $581,986 and a relative cost savings of 55 percent for isoproterenol, according to the authors.
Khot and colleagues projected the cost of the two drugs for 2014-2015 using pharmaceutical utilization patterns from 2012-2013. They then subtracted the actual costs using the alternative strategy to determine savings.
“No major patient-safety or clinical-outcome issues were noted,” the authors wrote. “Detailed comparative studies of clinical outcomes associated with the therapeutic alternatives are ongoing.”
The researchers noted their process could be applied to other drugs that undergo sharp price increases and could be used by other healthcare systems.