Balancing efficacy with cost: antiemetic control in the pediatric stem cell transplant (SCT) population

We studied the practice patterns regarding intravenous (i.v.) ondansetron i n children receiving stem cell transplants (SCT) at The Children's Hospital , Boston to identify cost efficiencies. The pharmacy provided information o n material and preparation costs on 36 patients who received i.v. ondansetr on during 41 SCT in 1995, We examined the effects of frequency, duration, a nd route of administration on costs, There were 498 days of ondansetron adm inistration costing $49 083 (95$), Tremendous variation existed in frequenc y and duration with one third receiving i.v. ondansetron once daily, despit e published evidence of equivalence of once a day and divided dosing. A swi tch to once daily i.v. dosing for all patients would have resulted in great er than or equal to 28% savings. The median duration of use was 11 days (ra nge 1-48); placing a cap for 7-10 days based on the length of SCT condition ing regimens, would produce savings of 48-60% over current use. By shifting administration route from i.v. to oral, a savings of 67% over current use, without a cap on duration, would be realized. Identifying areas for cost s avings can be achieved after thorough analysis of all the component costs, We demonstrated that significant cost reductions could be realized by simpl e changes in prescribing practices without jeopardizing efficacy. These sav ings are achieved by standardizing dosing interval, route of administration and duration of treatment without altering daily dosage or access to an ef fective antiemetic.