title: Identification of Cost-Saving Opportunities for the Use of Antithrombin III in Adult and Pediatric Patients.
abstract: Thrombate III is a human plasma-derived antithrombin III (AT-III) often utilized in patients on extracorporeal membrane oxygenation (ECMO) with suspected AT-III-mediated heparin resistance. It is supplied as 500-U and 1000-U vials, costing US$4.66 per unit. Literature is limited in describing the clinical value of AT-III in relation to its high cost. The primary objective was to determine conditions of use and associated cost of potentially unnecessary utilization of AT-III at The Johns Hopkins Hospital. Secondary objectives included evaluating the effect of AT-III on anticoagulation parameters and the overall cost utilized and wasted on AT-III. A retrospective cohort study was performed. The primary end point was the total cost associated with potentially unnecessary utilization of AT-III. There were 326 doses of AT-III administered to 65 patients in 2014. There were 177 (54%) potentially unnecessary doses associated with a cost of US$541 634. Antithrombin III repletion significantly increased median AT-III levels in non-ECMO and ECMO patients compared to baseline (non-ECMO: 62% vs 81%, P < .01; ECMO: 63% vs 81%, P < .01); however, 37.3% of ECMO and 49% of non-ECMO patients had therapeutic anticoagulation monitoring parameters prior to administration. A total cost of US$688 478 was spent on administered AT-III and US$417 194 (38%) was wasted. Utilizing restriction criteria and a new dosing strategy potentially results in estimated annual savings of US$556 000. Utilizing restriction criteria and alternative dosing strategies to mitigate waste and unnecessary use has the potential to result in significant cost savings.
authors.affiliation: 1 Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA.
authors.forename: Alana
authors.initials: A
authors.lastname: Ciolek
authors.affiliation: 2 Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: John
authors.initials: J
authors.lastname: Lindsley
authors.affiliation: 2 Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Crow
authors.affiliation: 3 Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, MD, USA.|4 Department of Pediatrics, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Nelson-McMillan
authors.affiliation: 2 Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: David
authors.initials: D
authors.lastname: Procaccini
mesh_terms: D000293:Adolescent; D000328:Adult; D000990:Antithrombin III / Q000008:administration & dosage* / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D015199:Extracorporeal Membrane Oxygenation / Q000191:economics* / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000990:Antithrombin III
keywords: ECMO; antithrombin; cardiac surgery; cost; pediatric