Event Title
Location
Georgia Campus
Start Date
1-5-2013 2:00 PM
End Date
1-5-2013 4:00 PM
Description
Purpose: To determine if any cost avoidance would occur by utilizing an automatic therapeutic interchange of racemic albuterol for levalbuterol in a health system.
Background: Levalbuterol may be prescribed in place of racemic albuterol to help decrease the adverse effects thought to be mediated by the S-enantiomer in racemic albuterol. However, a review of literature shows conflicting evidence. Additionally, the levalbuterol cost range is 3.5 to 25 times higher than the cost for racemic albuterol. With this in mind, we want to determine if a health system can avoid costs by utilizing an automatic therapeutic interchange of racemic albuterol for levalbuterol. We also wanted to compare cost avoidance across a range of conversion rates, as we hypothesize that obtaining a 100% interchange rate from levalbuterol to racemic albuterol may be difficult.
Methods: An annual drug usage evaluation for levalbuterol 0.625mg and 1.25mg was completed for the time period of January 1, 2012 through January 31, 2013 across all patient populations. The annual cost avoidance of automatically substituting racemic albuterol in place of levalbuterol was determined by comparing the purchase costs and usage of levalbuterol 0.625mg and levalbuterol 1.25mg against the purchase costs of racemic albuterol 1.25mg and racemic albuterol 2.5mg. Racemic albuterol is a 50:50 mix of R- and S-enantiomers, whereas levalbuterol includes only the R-enantiomer. The consensus standard of substitution of racemic albuterol for levalbuterol occurs with a 2:1 ratio (e.g. albuterol 2.5 mg for levalbuterol 1.25 mg and albuterol 1.25mg for levalbuterol 0.625mg). Cost avoidance in this study was calculated using this ratio for interchange. Additionally, the cost avoidance at interchange rates between 70% through 100% was calculated, as obtaining a full interchange of levalbuterol to racemic albuterol may be unrealistic.
Results: There was a total of 15096 units of levalbuterol 0.625mg and 17214 units of levalbuterol 1.25mg used in the specified time period at an annual spending of $49816 and $68823, respectively. At an interchange rate of 70% up to the full interchange rate of 100%, total cost avoidance was in the range of $71186 to $101695.
Conclusions: The automatic therapeutic interchange of racemic albuterol in place of levalbuterol in a health system yields an annual cost avoidance from $71186 to $101695, depending on the annual rate of interchange. A protocol for automatic therapeutic interchange of racemic albuterol for levalbuterol can offer substantial savings, even at interchange rates of less than 100%.
Included in
Cost Avoidance of Using an Automatic Therapeutic Interchange of Racemic Albuterol in Place of Levalbuterol
Georgia Campus
Purpose: To determine if any cost avoidance would occur by utilizing an automatic therapeutic interchange of racemic albuterol for levalbuterol in a health system.
Background: Levalbuterol may be prescribed in place of racemic albuterol to help decrease the adverse effects thought to be mediated by the S-enantiomer in racemic albuterol. However, a review of literature shows conflicting evidence. Additionally, the levalbuterol cost range is 3.5 to 25 times higher than the cost for racemic albuterol. With this in mind, we want to determine if a health system can avoid costs by utilizing an automatic therapeutic interchange of racemic albuterol for levalbuterol. We also wanted to compare cost avoidance across a range of conversion rates, as we hypothesize that obtaining a 100% interchange rate from levalbuterol to racemic albuterol may be difficult.
Methods: An annual drug usage evaluation for levalbuterol 0.625mg and 1.25mg was completed for the time period of January 1, 2012 through January 31, 2013 across all patient populations. The annual cost avoidance of automatically substituting racemic albuterol in place of levalbuterol was determined by comparing the purchase costs and usage of levalbuterol 0.625mg and levalbuterol 1.25mg against the purchase costs of racemic albuterol 1.25mg and racemic albuterol 2.5mg. Racemic albuterol is a 50:50 mix of R- and S-enantiomers, whereas levalbuterol includes only the R-enantiomer. The consensus standard of substitution of racemic albuterol for levalbuterol occurs with a 2:1 ratio (e.g. albuterol 2.5 mg for levalbuterol 1.25 mg and albuterol 1.25mg for levalbuterol 0.625mg). Cost avoidance in this study was calculated using this ratio for interchange. Additionally, the cost avoidance at interchange rates between 70% through 100% was calculated, as obtaining a full interchange of levalbuterol to racemic albuterol may be unrealistic.
Results: There was a total of 15096 units of levalbuterol 0.625mg and 17214 units of levalbuterol 1.25mg used in the specified time period at an annual spending of $49816 and $68823, respectively. At an interchange rate of 70% up to the full interchange rate of 100%, total cost avoidance was in the range of $71186 to $101695.
Conclusions: The automatic therapeutic interchange of racemic albuterol in place of levalbuterol in a health system yields an annual cost avoidance from $71186 to $101695, depending on the annual rate of interchange. A protocol for automatic therapeutic interchange of racemic albuterol for levalbuterol can offer substantial savings, even at interchange rates of less than 100%.