title: Cost Reduction of Inhaled Tobramycin by Use of Preservative-Free Intravenous Tobramycin Given via Inhalation.
abstract: This study evaluates drug cost outcomes related to automatic therapeutic substitution of branded tobramycin solution for inhalation (TOBI(®)) with inhaled generic preservative-free intravenous tobramycin (PFIT). A retrospective single-center evaluation of inhaled tobramycin use from 2008 through 2012 was performed. Number of doses dispensed and acquisition costs were obtained. Hourly wage data was acquired, pharmacy production costs were estimated and total cost-savings calculated. Days of therapy (DOTs) were determined for each year. Quality assurance and safety data was collected. In 2008, TOBI(®) drug costs and doses dispensed were $118,665 and 1769, respectively. Following implementation of the interchange in May 2009, TOBI(®) utilization ceased. PFIT costs in 2010 through 2012 averaged $34,775 annually and TOBI(®) cost-avoidance exceeded $94,000 annually when accounting for pharmacy production costs, which were determined to be at most $5.28 per dose. The maximum estimated pharmacy production cost ranged from $8812 to $11,299 annually. PFIT doses dispensed exceeded 1650 each year and annual DOTs ranged from 815 to 1069. The 40-month savings were calculated to be $374,706. Quality assurance and safety data identified one patient who refused PFIT due to odor complaints and one patient who was inappropriately administered a dose orally. Therapeutic substitution of TOBI(®) with PFIT can produce immediate and sustained savings with an acceptable safety profile.
authors.affiliation: Department of Pharmacy, Miami Veterans Affairs Healthcare System, 1201 NW 16th Street, Miami, FL 33125, USA. timothypgauthier@gmail.com.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Gauthier
authors.affiliation: Department of Pharmacy, University of Minnesota Medical Center, 420 Delaware Street, Minneapolis, MN 55455, USA. Jwasko1@fairview.org.
authors.forename: Justin
authors.initials: J
authors.lastname: Wasko
authors.affiliation: College of Pharmacy, Nova Southeastern University, 11501 North Military Trail, Palm Beach Gardens, FL 33410, USA. NUnger@nova.edu.
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Unger
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 2101 NW 117th Avenue, Miami, FL 33172, USA. labbo@med.miami.edu.
authors.forename: Lilian M
authors.initials: LM
authors.lastname: Abbo
authors.affiliation: Department of Pharmacy, Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL 33125, USA. Mferandez7@jhsmiami.org.
authors.forename: Margaret
authors.initials: M
authors.lastname: Fernandez
authors.affiliation: Department of Pharmacy, Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL 33125, USA. lsmith5@jhsmiami.org.
authors.forename: Laura
authors.initials: L
authors.lastname: Aragon
keywords: inhaled antibiotics; pharmacotherapy; pharmacy