Cost savings using a stepped-care prescribing protocol for nonsteroidal anti-inflammatory drugs

• HIT Description: Cost reminder appeared on the computer ordering screen More info...
  
• Purpose of Study: Lower nonsteroidal anti-inflammatory drug (NSAID) costs
  
• Years of study: Beginning in April 1992 for 21 months
  
• Study Design: Before and after trial with one study site and two control sites
  
• Outcomes: The expensive NSAIDs prescription rate and costs, clinician acceptance and patient impact
  

• Settings: Madigan Army Medical Center, Tacoma, Washington, and two affiliated primary care clinics
• Intervention: The intervention site implemented an NSAID prescribing protocol that required either ibuprofen or indomenthacin before new prescription of more expensive NSAIDS. One control center used an NSAID computer cost-prompt and the other had usual practice.
• Evaluation Method: Pre-post; prescribing data were collected using a pharmacy computer system; clinician questionnaire were sent to 203 clinicians
• HIT System: Cost reminder appeared on the computer ordering screen of the control clinic at the beginning of the trial
• Extrinsic Factors in valuing cost and benefits: Patients are active-duty military personnel and their families. Patients received their prescriptions free at the pharmacies adjacent to the study military outpatient clinics.
• Cost of Implementation: The protocol implementation required an annual hospital cost of $4400. The cost of computer reminder was not reported.
• Healthcare Utilization: Quarterly use of expensive NSAIDs at the intervention site fell from 34% to 21%, while at computer cost-prompt site it decreased only 5%, and at usual practice control site it increased 2%.
• Quality of Care and Patient Safety Outcome: Intervention site clinicians reported very rare protocol-related patient care problems.
• Changes in healthcare costs: The volume-adjusted savings during the last 12 months of the study were $152,800 (using 1992 NSAID acquisition prices), decreasing cost by 30% at study site.
• Changes in efficiency and productivity: A minority (9%) of the responding clinicians felt the protocol continued to be very bothersome and 2% felt it should be discontinued.�