Reducing Cost and Intravenous Duration of Nicardipine in Intracerebral Hemorrhage Patients via an Interdisciplinary Approach.
BACKGROUND
The mainstay of acute management of intracerebral hemorrhage (ICH) is blood pressure reduction. Intravenous (IV) nicardipine is an effective but costly intervention for blood pressure reduction in the intensive care unit (ICU). Earlier transition to oral (PO) antihypertensive agents may reduce ICU length of stay (LOS) and associated costs. We sought to study the effectiveness of an interdisciplinary intervention to start earlier transition to PO antihypertensives.


METHODS
From July 2011 to July 2012, patients with ICH who received IV nicardipine were reviewed and screened for eligibility by an interdisciplinary team including physicians and pharmacists. These patients were compared to a control group 1 year prior to this intervention. The duration of nicardipine treatment (median hours), estimated costs, and ICU LOS were measured.


RESULTS
A total of 35 patients and 44 controls were studied. The median hours of IV nicardipine use were significantly decreased from a baseline mean of 118 to 30 hours (P < .001); total cost savings per year was $433,566 ($18,475 per patient). The average LOS remained similar (8.4 versus 8.9 days, P < .990). In a follow-up study 1 year later, after the intervention was no longer used, a sample of 21 consecutive patients was reviewed and the duration of IV nicardipine treatment had increased to a mean of 96 hours.


CONCLUSIONS
A physician and pharmacist-led project to initiate oral antihyperintensive medications earlier was successful in reducing the duration of IV nicardipine treatment in patients with ICH while leading to substantial cost savings.
Department of Neurology, University of California San Francisco, San Francisco, California. Electronic address: Nirav.shah@ucsf.edu.
Nirav H
NH
Shah
Department of Neurology, Kaiser-Permanente Santa Clara, Santa Clara, California.
Lynn V
LV
Do
Department of Neurology, Kaiser-Permanente Santa Clara, Santa Clara, California.
Justin
J
Petrovich
Department of Neurology, Kaiser-Permanente Santa Clara, Santa Clara, California.
Kathryn
K
Crozier
Department of Pharmacy, University of California San Francisco, San Francisco, California.
Carmil
C
Azran
Department of Neurology, University of California San Francisco, San Francisco, California.
S Andrew
SA
Josephson
D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000008:administration & dosage* / Q000191:economics*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage* / Q000191:economics*
D014665:Vasodilator Agents; D009529:Nicardipine
ICH; Stroke; cost-effectiveness; intracerebral hemorrhage; neuro-ICU; neurocritical care; nicardipine; quality improvement