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Reducing Cost and Intravenous Duration of Nicardipine in Intracerebral Hemorrhage Patients via an Interdisciplinary
Nirav H Shah1, Lynn V Do2, Justin Petrovich2
1Department of Neurology, University of California San Francisco, San Francisco, California.
Insights
An interdisciplinary team successfully reduced intravenous nicardipine use in intracerebral hemorrhage patients, cutting costs significantly. Earlier transition to oral medications proved effective for managing blood pressure and reducing healthcare expenses.
Area of Science:
- Neurology
- Critical Care Medicine
- Pharmacology
Background:
- Intracerebral hemorrhage (ICH) management primarily involves blood pressure reduction.
- Intravenous (IV) nicardipine is effective but costly for acute ICH care in the intensive care unit (ICU).
- Earlier transition to oral (PO) antihypertensives may decrease ICU length of stay (LOS) and associated costs.
Purpose of the Study:
- To evaluate the effectiveness of an interdisciplinary intervention for earlier transition to PO antihypertensives in ICH patients.
- To assess the impact of this intervention on IV nicardipine duration, costs, and ICU LOS.
Main Methods:
- A retrospective review of ICH patients receiving IV nicardipine from July 2011 to July 2012.
- Comparison of patients undergoing an interdisciplinary intervention (physicians and pharmacists) with a control group from the prior year.
- Measurement of IV nicardipine duration, estimated costs, and ICU LOS.
Main Results:
- The intervention significantly decreased median IV nicardipine duration from 118 to 30 hours (P < .001).
- Substantial cost savings of $433,566 annually ($18,475 per patient) were achieved.
- Average ICU LOS remained similar (8.4 vs. 8.9 days, P < .990).
- A follow-up showed increased IV nicardipine duration to 96 hours after the intervention ceased.
Conclusions:
- A physician and pharmacist-led initiative effectively reduced IV nicardipine treatment duration in ICH patients.
- The intervention led to significant cost savings without impacting ICU length of stay.
- Sustaining such interventions is crucial for continued cost-effectiveness in ICH management.
Background:
The mainstay of acute management of intracerebral hemorrhage (ICH) is blood pressure reduction. Intravenous (IV) nicardipine is an effective but costly intervention for blood pressure reduction in the intensive care unit (ICU). Earlier transition to oral (PO) antihypertensive agents may reduce ICU length of stay (LOS) and associated costs. We sought to study the effectiveness of an interdisciplinary intervention to start earlier transition to PO antihypertensives.
Methods:
From July 2011 to July 2012, patients with ICH who received IV nicardipine were reviewed and screened for eligibility by an interdisciplinary team including physicians and pharmacists. These patients were compared to a control group 1 year prior to this intervention. The duration of nicardipine treatment (median hours), estimated costs, and ICU LOS were measured.
Results:
A total of 35 patients and 44 controls were studied. The median hours of IV nicardipine use were significantly decreased from a baseline mean of 118 to 30 hours (P < .001); total cost savings per year was $433,566 ($18,475 per patient). The average LOS remained similar (8.4 versus 8.9 days, P < .990). In a follow-up study 1 year later, after the intervention was no longer used, a sample of 21 consecutive patients was reviewed and the duration of IV nicardipine treatment had increased to a mean of 96 hours.
Conclusion:
A physician and pharmacist-led project to initiate oral antihyperintensive medications earlier was successful in reducing the duration of IV nicardipine treatment in patients with ICH while leading to substantial cost savings.
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