Drug price increases remain a dominant topic in the national conversation around managing and reducing health system costs. Just as patients may find themselves struggling to afford much-needed medications, healthcare leaders must often make difficult operational decisions to absorb or mitigate drug price increases within their organizations.
而药品价格的上涨在很大程度上仍在制药商的控制之下, health systems are introducing several approaches to address the burden and impact associated with these rising costs.
方法一:引入替代疗法
For both health systems and patients, drug price increases can result in material negative impacts. A 芝加哥大学报告 commissioned by the American Hospital Association found that changes to drug prices significantly outpaced Medicare payment rate updates, with the average drug spend per admission increasing nearly 19% between 2015 and 2017. 接受调查的高管中, two-thirds indicated these changes moderately or severely impacted operating budgets. 为了抵消昂贵的药费, 云顶集团40011官网领导人被迫在其他地方降低成本, 通常是裁员或延迟更换设备.
These resulting challenges have prompted hospital leaders to seek less-costly drug alternatives where available as a way to help mitigate costs. 下面的案例研究提供了高成本替代方案的例子, 常用药品, which have the potential to result in significant savings for hospitals without compromising clinical outcomes.
例一:克利维地平作为硝普钠的替代品
被称为“恶性通货膨胀药”,“硝普钠, 尽管它是通用的, 将其批发价格提高到同样高 从2013年到2017年,每瓶为900美元. 结果是, some hospitals began investigating other therapeutically equivalent drugs for the treatment of perioperative hypertension in cardiac surgery patients. 一组药房工作人员, 心脏外科云顶集团40011官网, 麻醉医师, 和恩格尔伍德医院的重症监护医师, a 520-bed community teaching hospital in New Jersey that performs more than 300 cardiac surgeries per year, identified clevidipine as an acceptable therapeutic alternative and was able to achieve approximately $300,000 in annual cost savings largely because the acquisition cost of clevidipine is less than 10% of sodium nitroprusside on a per vial basis. 同样的, 克利夫兰诊所 节省超过800万美元 by adjusting medication ordering options and switching from nitroprusside to the therapeutic alternative nitroglycerin without any major patient safety or clinical outcome issues.
例二:多巴酚丁胺作为异丙肾上腺素的替代品
心脏药物异丙肾上腺素的每毫克价格从 $26.20 to $1,790.在三年的时间里. While physicians at 克利夫兰诊所 were unable to find an acceptable alternative for isoproterenol in electrophysiology testing, they did begin using dobutamine as an alternative to isoproterenol for intraoperative testing of myectomy patients. In doing so, the organization realized over $580,000 in annual cost savings. 类似地, 心血管云顶集团专线 在Atrium Health的Sanger Heart & 血管研究所最初节省了380美元的费用,在消融术中用多巴酚丁胺代替异丙肾上腺素, with no change in diagnostic performance as assessed by electrophysiology physicians.
例三:Ziextenzo和Udenyca作为Neulasta的替代品
Neulasta的标价, 用于治疗化疗患者中性粒细胞减少症的生物制剂, 自2002年获得FDA批准以来增长了近两倍,现在代表了 每年40亿美元的成本负担 在美国. A biosimilar product, Ziextenzo, was recently released by Novartis and priced at a 37%的折扣 对Neulasta. 另一个生物仿制, Udenyca在考虑成本改革的情况下,FDA制定并批准了该产品. Udenyca has demonstrated a price increase of only 27% on the consumer price index from 2009 to 2018, 相比之下,Neulasta同期的增长率为132%. The cost of cancer care represents a significant burden to patients and providers, and these new alternatives may represent less-costly treatment options that could positively impact patients and the healthcare industry at large.
方法二:实施以药学和信息技术为重点的战略
除了引入替代药物疗法, providers can utilize several operations-focused approaches to achieve efficiencies and cost savings.
与药剂师合作. Healthcare organizations can help ensure patients receive high-value drug options through the creation of evidence-based formularies and the deeper engagement of pharmacists as members of the clinical team. Clinical pharmacists can teach providers about treatment options that are less expensive but equally efficacious, potentially kickstarting conversations around alternative therapies or new protocol development. Other significant outcomes of a pharmacist-physician partnership may include reductions in prescribing variation and the establishment of use standards for certain drugs and drug regimens in various clinical circumstances, which in turn would aid in controlling variable costs associated with individual prescribing preferences. 此外, the use of control mechanisms within the electronic health record (EHR) could assist with reducing costs and mitigating nonformulary prescribing practices.
实现实时效益工具(rtbt). Providers often have limited or inaccurate drug cost information to assist them in making drug-related decisions. New RTBTs offer cost transparency and clinical decision support for providers at the point of prescribing. 例如, RxRevu is one such tool that can be integrated into Epic and Cerner EHR systems to supply prescribers with cost data, 以证据为基础的替代方案, 之前的授权, 病人实时分享支付信息. Such RTBTs frequently lead to a lower-cost option being chosen as the drug of choice.
改善库存管理. 最低和最高放养水平, 再订购点, and reorder quantities should be established and reviewed on a routine schedule and revised as necessary, 尤其适用于高、中成本产品. 北卡罗来纳的一家癌症医院做到了 从2011财年到2018财年,将药品浪费成本降低94% 通过a的实现 药瓶优化策略 在输液和住院药房. 如本例所示, reducing IV drug waste and ensuring proper inventory management are both effective methods to lessen unnecessary pharmaceutical expenditures. 其他机会包括:
- 制定静脉注射到口腔的转换计划.
- 限制批量大小.
- 缩短准备静脉注射剂量和实际给药之间的时间.
此外, 通过跟踪和审核IV混合废物, hospital leadership can identify common occurrences and develop the necessary solutions to address them.
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2020年7月23日发布