Antiulcer therapy: an exercise in formulary management

Area of Science:

• Pharmacoeconomics
• Hospital Pharmacy Management
• Drug Utilization Review

Background:

• H2-receptor antagonists (histamine H2-receptor antagonists) are a high-cost drug class in hospital settings.
• A significant portion of H2-receptor antagonist use is for stress ulcer prophylaxis.
• Formulary management aims to control healthcare costs while maintaining quality of care.

Purpose of the Study:

• To evaluate the cost-saving potential of restricting H2-receptor antagonist use through formulary management.
• To assess the impact of switching from ranitidine to cimetidine on drug costs and patient outcomes.

Main Methods:

• Pharmacy cost review identified H2-receptor antagonists as a high-cost drug group.
• A committee reviewed data and deemed H2-receptor antagonists therapeutically equivalent.
• Formulary decision shifted inpatient use from 90% ranitidine to 90% cimetidine, targeting a 36% cost saving.

Main Results:

• The switch to cimetidine resulted in significant cost savings.
• Monitoring showed no increase in elevated drug levels for theophylline, phenytoin, or lidocaine.
• No difference in theophylline toxicity was observed between cimetidine and ranitidine use.
• The incidence of stress ulcer bleeding remained low at 1.4% post-implementation.

Conclusions:

• Cost-effective formulary restriction of H2-receptor antagonists is achievable.
• Decisions based on scientific data can lead to cost savings without compromising patient care quality.
• Formulary management strategies can optimize drug spending effectively.