Nesiritide utilization evaluation in a university teaching hospital

Area of Science:

• Cardiology
• Pharmacology
• Health Economics

Background:

• Nesiritide is a vasodilator approved for decompensated heart failure (DHF).
• It offers short-term hemodynamic and symptomatic improvement compared to nitroglycerin but is significantly more expensive.
• Increasing institutional use prompted a drug utilization evaluation.

Purpose of the Study:

• To evaluate the utilization patterns of nesiritide in a hospital setting.
• To identify inappropriate uses of nesiritide and estimate associated costs.
• To develop guidelines for appropriate nesiritide usage.

Main Methods:

• Retrospective review of 162 patient records who received nesiritide between October 2003 and March 2004.
• Analysis of nesiritide utilization patterns, duration of therapy, and patient outcomes.
• Calculation of potential cost savings from eliminating inappropriate use.

Main Results:

• 22.6% of nesiritide usage was deemed inappropriate, primarily in non-DHF indications like pre-cardiac surgery optimization and non-cardiac fluid overload.
• The median duration of nesiritide therapy was 6 days, contributing to a longer length of stay (14 days) compared to national DHF averages (5.3 days).
• Potential annual cost savings of US$141,886 were identified by addressing inappropriate nesiritide use.

Conclusions:

• A 48-hour restriction policy for nesiritide was implemented, requiring Heart Failure Service approval for extended use.
• Further evaluations will assess the policy's effectiveness in optimizing nesiritide use and improving DHF management.
• The study highlights the need for careful drug utilization initiatives to control costs and enhance patient care efficiency.