title: Strategies for reduction in the duration of intravenous drug use: Interest of drug tracers as quality indicators to improve intravenous to oral switch.
abstract: OBJECTIVE
  Intravenous (IV) to oral (PO) drug switch is a challenge for tertiary care institutions for several reasons: catheter-related infections, patient's pain and discomfort or higher costs, and overuse of IV drugs considered as an irrational use of medicines. The objective was to evaluate yearly acetaminophen and proton-pump inhibiters' (PPIs) IV/PO ratios from 2011 to 2015 and to determine their correlation with all drugs IV/PO ratios and their relevance as drug tracers. A secondary objective was to estimate costs savings associated with a IV to PO switch improvement.
  
  
  METHODS
  Data on IV and PO consumptions and impact on costs were presented to physicians yearly, followed by the development of a computerized tool and pharmaceutical validation of prescriptions. Intravenous and PO drug consumptions were extracted yearly for all drugs, acetaminophen, and PPIs from 2011-01-01 to 2015-12-31. Acetaminophen and PPIs' IV/PO ratios were compared to IV/PO consumptions for all drugs. Costs savings associated with this switch were calculated yearly by multiplying the difference in average cost per dose by the total number of doses delivered (fixed purchase prices, euros) for both routes.
  
  
  RESULTS
  All drugs IV/PO ratio decreased every year to achieve a 16.3% reduction between 2011 and 2015. Acetaminophen and PPIs also decreased respectively by 35.5% and 16.5%. Same tendency of decrease of ratios year by year was noted for all drugs, PPIs, and acetaminophen. Savings for both acetaminophen and PPIs IV/PO switch were over 98 000€ for 5 years.
  
  
  CONCLUSIONS
  This study demonstrated that acetaminophen IV/PO ratio, easily produced in routine, was a relevant tracer to follow IV/PO switch improvement as it was correlated with all drugs IV/PO ratio. Direct cost savings associated with IV/PO switch improvements were consequent and illustrate well the impact of our approach on the efficiency of therapeutics' management.
authors.affiliation: Department of Pharmacy, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
authors.forename: Jennifer
authors.identifier: http://orcid.org/0000-0003-4303-6479
authors.initials: J
authors.lastname: Corny
authors.affiliation: Department of Pharmacy, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
authors.forename: Simon
authors.initials: S
authors.lastname: Perreau
authors.affiliation: Department of Pharmacy, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
authors.forename: Anne-Pauline
authors.initials: AP
authors.lastname: Thivilliers
authors.affiliation: Department of Pharmacy, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Leplay
authors.affiliation: Department of Pharmacy, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Chevalier
authors.affiliation: Clinical Research Center, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Beaussier
authors.affiliation: Department of Pharmacy, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
authors.forename: Yvonnick
authors.initials: Y
authors.lastname: Bézie
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage* / Q000191:economics*; D061605:Administration, Intravenous; D000284:Administration, Oral; D003365:Costs and Cost Analysis; D004333:Drug Administration Routes; D006801:Humans; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000191:economics*
chemical_list: D054328:Proton Pump Inhibitors; D000082:Acetaminophen
keywords: clinical safety; evaluation; health economics; healthcare