title: Benchmark analysis of strategies hospitals use to control antimicrobial expenditures.
abstract: Hospital expenditures on antimicrobial drugs, antimicrobial management practices, and the effects of these practices were studied. A survey on institutional budget, size, and staffing; intensive care unit drug costs and use evaluations; and pharmacy expenditures, including antimicrobial costs, for 1993 and 1994 was sent to 122 hospitals. The written survey was followed by telephoned questions regarding each institution's antimicrobial management and expenditures, and any perceived link between the two. Hospitals were grouped by size and type, data were normalized to costs per occupied bed and costs per occupied bed per case mix index, and averages for each size category were calculated for general institutional information and expenses per antimicrobial. Eighty-eight institutions (72%) responded. Although 61% to 74% of the respondents used an antimicrobial formulary to restrict drug choices and control costs, average total antimicrobial expenses increased by more than $300 per occupied bed between 1993 and 1994. Only 7% of the institutions saw decreased costs of $500 or more per occupied bed. The most common reasons for these decreases were restructuring of pricing contracts and implementation of educational programs. The replacement of one formulary alternative with another led to increases in the use of antimicrobials other than the replacement drug and often did not produce savings. The replacement of one formulary antimicrobial with another led more to costshifting than to overall savings.
authors.affiliation: Clinical Pharmacokinetics Laboratory Millard Fillmore Health System, Buffalo, NY 14209, USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Rifenburg
authors.forename: J A
authors.initials: JA
authors.lastname: Paladino
authors.forename: S C
authors.initials: SC
authors.lastname: Hanson
authors.forename: J A
authors.initials: JA
authors.lastname: Tuttle
authors.forename: J J
authors.initials: JJ
authors.lastname: Schentag
mesh_terms: D000900:Anti-Bacterial Agents / Q000191:economics*; D003363:Cost Control; D004352:Drug Resistance, Microbial; D005572:Formularies, Hospital as Topic; D017048:Health Care Costs; D017721:Hospital Costs / Q000592:standards*; D006801:Humans; D011795:Surveys and Questionnaires
chemical_list: D000900:Anti-Bacterial Agents