Cost-effectiveness and value of an IV switch

Area of Science:

• Pharmacology
• Infectious Diseases
• Hospital Pharmacy

Background:

• Antibiotic therapy often involves intravenous (IV) administration, with a transition to oral (PO) therapy (stepdown) when clinically appropriate.
• Some antibiotics offer both IV and PO formulations with equivalent bioavailability (e.g., metronidazole, clindamycin, ciprofloxacin), facilitating seamless IV-PO stepdown.
• Many parenteral antibiotics lack oral formulations or have poor oral bioavailability, complicating stepdown strategies.

Purpose of the Study:

• To evaluate the implementation and outcomes of IV-PO antibiotic stepdown programs.
• To identify factors influencing the success and timing of IV-PO antibiotic stepdowns.
• To assess the economic impact and clinical appropriateness of IV-PO antibiotic stepdown protocols.

Main Methods:

• Retrospective review of IV-PO stepdown programs at Vancouver General Hospital over a 4-year period.
• Analysis of patient selection criteria, timing of stepdown, and clinical outcomes.
• Economic evaluation of cost savings associated with successful IV-PO stepdowns.

Main Results:

• Vancouver General Hospital achieved significant cost savings (approximately $C85,000) through metronidazole and clindamycin IV-PO stepdown programs.
• Not all patients receiving parenteral antibiotics are suitable candidates for oral stepdown.
• Significant delays in oral stepdown were observed, and in some cases, stepdown did not occur when appropriate.

Conclusions:

• IV-PO antibiotic stepdown is a viable strategy for cost savings and maintaining therapeutic equivalence when appropriate antibiotics and patient selection criteria are used.
• Optimizing the timing and patient selection for IV-PO stepdown is crucial to maximize benefits and avoid potential negative clinical consequences.
• Further refinement of protocols is needed to ensure timely and appropriate IV-PO antibiotic stepdowns for eligible patients.