Drug utilization review on a tertiary palliative care unit

Area of Science:

• Palliative Care Medicine
• Health Economics
• Pharmacology

Background:

• Palliative care relies heavily on medications, contributing significantly to healthcare costs.
• A 40% increase in drug expenditures was observed in a Tertiary Palliative Care Unit (TPCU) in 2002.
• Injectable fentanyl, oral/injectable ondansetron, and total parenteral nutrition (TPN) accounted for 55% of this increase, driven by utilization, not cost per unit.

Purpose of the Study:

• To investigate if the increased utilization of key drugs in a TPCU during 2002 was justified by appropriate prescribing.
• To compare the indications for prescribing fentanyl, ondansetron, and TPN against evidence- and consensus-based criteria.

Main Methods:

• Retrospective analysis of drug prescriptions for patients admitted to the TPCU in 2002.
• Identification of drug utilization through the pharmacy database.
• Development of evidence- and consensus-based criteria to evaluate prescribing indications.

Main Results:

• Fentanyl prescriptions met criteria in 26 of 29 cases, primarily for managing pain after other opioids failed or for rapid titration.
• Ondansetron prescriptions met criteria in 19 of 21 cases, mainly for refractory nausea or nausea related to cancer treatments.
• Total parenteral nutrition (TPN) initiation met criteria in only 1 of 5 cases, though it was often continued in imminent death scenarios pending family consultation.

Conclusions:

• The increased prescribing of fentanyl and ondansetron in the TPCU largely aligned with evidence- and consensus-based criteria, justifying the expenditure increase.
• The study highlights the utility of analyzing drug utilization patterns when expenditures rise.
• Further investigation into TPN discontinuation in palliative care and cost-effectiveness analyses are recommended.