Financial impact of formulary revision of second-generation cephalosporins

Hospitals are under increasing pressure to reduce the costs of treating patients. Due to their high cost and wide usage, antibiotics are frequently targeted for cost containment. In January of 1986, a drug formulary revision program was initiated wherein cefuroxime was automatically substituted for cefamandole unless the ordering physician specifically stated otherwise. Since these antibiotics are usually ordered in different standard doses, a table of comparable doses was prepared and approved by the hospital Pharmacy and Therapeutics Committee. Costs for both drugs were calculated from pharmacy drug acquisition records. A list was prepared of all patients who had received cefamandole from January 1, 1985 to June 30, 1985 and cefuroxime from January 1, 1986 to June, 1986. Forty patients who had received cefamandole and 31 patients who had received cefuroxime were identified. During the period of review in 1986, no orders requiring the substitution of cefamandole with cefuroxime were written. The cost avoidance by using cefuroxime was approximately $3,000 (41 percent) while the cost of instituting the program was negligible.