Evaluating the Utilization and Cost Analysis of High-dose Thiamine when Compounded or Administered Via Intravenous...

Thiamine doses greater than 200 mg are typically prepared as an IV piggyback (IVPB) and administered over 30 minutes to reduce the risk of adverse events (AE) associated with administration. Administration of high-dose (HD) thiamine as an IV push may reduce cost and clinical burden without increasing risk of AE.

This was a retrospective, single-center cohort analysis of hospitalized patients over the age of 18 years old admitted to the University of Colorado Hospital and receiving HD thiamine from June 1st, 2024 to October 31st, 2024. In August 2024, the preparation and administration of HD IV thiamine was changed from 500 mg IVPB administered over 30 minutes to 400 mg undiluted IV push over 2 minutes. The primary outcome was the average total cost comparing thiamine 500 mg IVPB versus 400 mg IV push. Secondary outcomes included cumulative dose administrations and AE.

A total of 731 patients met inclusion criteria with 339 (46%) receiving thiamine 500 mg IVPB infusion (2,493 doses) and 392 (54%) receiving thiamine 400 mg IV push (3,145 doses). The average total cost of HD thiamine therapy per patient was $91.12 for the 500 mg IVPB cohort and $59.05 for the 400 mg IV push cohort (p < 0.001). Additionally, the mean cumulative dose of thiamine administered was higher in the 500 mg IVPB cohort compared to the 400 mg IV push cohort (P = 0.002). Hypotension (0.5%) and burning sensation (1.0%) were only reported in the thiamine 400mg IV push group and were not statistically significant.

The institutional change from thiamine 500mg IVPB to thiamine 400mg undiluted IV push resulted in significant cost savings with minimal risk for adverse events.