A cost avoidance study of critical care pharmacists' interventions in a tertiary institution in Singapore

The economic impact of critical care pharmacists in the intensive care unit (ICU) setting has not been evaluated in Singapore despite ICUs being high-cost areas. This study was conducted to determine the costs avoided as a result of pharmacists' interventions within multidisciplinary ICU teams in a tertiary hospital in Singapore.

A single-center, retrospective observational study of accepted pharmacists' interventions was conducted over 6 months in 2020. We adopted a previously published systematic approach to estimate the costs avoided by the healthcare system through pharmacists' interventions. Interventions were independently reviewed by a critical care pharmacist, an intensivist, and an investigator. Cost avoidance was calculated in terms of the additional ICU length of stay that would have resulted had a pharmacist not intervened as well as the direct cost savings achieved.

There were 632 medication-related problems (MRPs) associated with the 527 accepted interventions, as some interventions involved multiple MRPs. The most common interventions included correcting inappropriate drug regimens (n = 363; 57%), recommending drug monitoring (n = 65; 10%) and addressing omission of drugs (n = 50; 8%). Over 6 months, gross cost avoidance and net cost avoidance achieved were $186,852 and $140,004, respectively, resulting in a ratio of potential monetary cost avoidance to pharmacist salary of 3.99:1. The top 3 interventions that resulted in the greatest cost avoidance were those that corrected inappropriate drug regimens ($146,870; 79%), avoided adverse drug events (ADEs) ($10,048; 5%), and led to discontinuation of medications without any indication ($7,239; 4%).

Pharmacists can reduce healthcare expenditure substantially through cost avoidance by performing various interventions in ICUs, particularly in the areas of correcting inappropriate drug regimens, avoiding ADEs, and discontinuing unnecessary medications.