Impact of an intravenous fluconazole restriction policy on patient outcomes.
OBJECTIVE
To evaluate both the economic and clinical impact of an intravenous fluconazole restriction policy in a university teaching hospital.


METHODS
Intravenous fluconazole was restricted to patients unable to take oral medications due to significant nausea or to patients whose oral intake was restricted. A retrospective chart review and computerized record review was conducted in patients receiving intravenous or oral fluconazole from January 1 to June 30, 1997, and again from January 1 to June 30, 1998, after implementation of the policy.


RESULTS
Six-month institutional expenditures for intravenous fluconazole decreased following policy implementation, from $81,900 to $45,400, an estimated annual institutional savings of $73,000. A 47% reduction in the number of patients treated with intravenous fluconazole was observed over the six-month period after policy implementation. During this time, the rate of successful clinical outcomes for documented or suspected disseminated Candida albicans infection or febrile neutropenia remained the same (66.6% prepolicy and 65.9% postpolicy; p = 0.95). Similarly, the number of deaths in patients receiving fluconazole remained unchanged (p = 0.31).


CONCLUSIONS
A restriction policy for intravenous fluconazole results in significant cost savings, with no significant decrease in successful outcomes or change in mortality.
Burkiewicz
J S
JS
School of Pharmacy, University of California, San Francisco, CA, USA. jburki@midwestern.edu
Kostiuk
K A
KA
Jacobs
R A
RA
Guglielmo
B J
BJ
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D017723:Drug Utilization Review / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D015725:Fluconazole; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D016134:Organizational Policy; D016896:Treatment Outcome
D015725:Fluconazole