Estimating Tiotropium Wasted Doses After Adding Revefenacin to an Inpatient Formulary: A Single-Center...

Area of Science:

• Pulmonary Medicine
• Hospital Pharmacy

Background:

• Revefenacin, a nebulized long-acting muscarinic antagonist (LAMA), is supplied in single-use vials.
• Multidose tiotropium inhalers are also used for LAMA therapy.
• The extent of wasted doses from multidose LAMA inhalers in hospitals is not well-documented.

Purpose of the Study:

• To compare dose wastage between single-use revefenacin vials and multidose tiotropium inhalers in hospitalized patients.
• To estimate the financial impact of wasted LAMA doses.

Main Methods:

• A single-center, descriptive, cross-sectional study was conducted from January 1, 2021, to December 31, 2021.
• Included were adult inpatients (≥18 years) at a 500-bed academic medical center who were prescribed multidose tiotropium or single-use revefenacin.
• Data collected on LAMA orders and wastage patterns.

Main Results:

• Out of 705 LAMA orders, 541 were tiotropium (76.7%) and 164 were revefenacin (23.3%).
• 91.5% of tiotropium orders resulted in 20-90% wastage of multidose packages.
• Approximately $24,000 in tiotropium doses were wasted, contrasting with single-use revefenacin vials.

Conclusions:

• Multidose tiotropium inhalers contributed to significant dose wastage in hospitalized patients compared to single-use revefenacin vials.
• Opportunities exist to minimize waste associated with multidose LAMA inhalers in hospital settings.
• Single-use vial formulations may offer a more cost-effective dispensing option for health-system pharmacies.