Strategies to decrease costs of prescribing selective serotonin reuptake inhibitors at a VA Medical Center

Area of Science:

• Health Economics
• Pharmacoeconomics
• Clinical Pharmacy

Background:

• Prescribing costs for selective serotonin reuptake inhibitors (SSRIs) can be substantial for healthcare institutions.
• Optimizing antidepressant prescribing is crucial for managing healthcare budgets.

Purpose of the Study:

• To evaluate the effectiveness of a multifaceted intervention aimed at controlling the costs associated with SSRI prescriptions.
• To assess the impact of provider education and system changes on antidepressant expenditure.

Main Methods:

• Intervention components included designating a preferred SSRI, promoting tablet splitting, providing prescriber education and feedback, and utilizing an electronic ordering system.
• VA databases were analyzed for antidepressant utilization and associated costs over 35 months.

Main Results:

• Despite an increase in treated patients and overall SSRI spending, the mean monthly cost per patient decreased from $57.12 to $42.19.
• Projected cost savings reached approximately $700,000 over 35 months, with tablet splitting contributing 25% and changes in SSRI proportions contributing 75%.
• Post-intervention surveys indicated high prescriber awareness of the preferred agent (citalopram) and its adoption as a first-line treatment.

Conclusions:

• Multifaceted interventions, combining provider education with pharmacy and information system enhancements, can significantly reduce antidepressant costs.
• These strategies lead to substantial cost savings for healthcare institutions while potentially maintaining or improving treatment patterns.