Impact of an intravenous fluconazole restriction policy on patient outcomes

OBJECTIVE: To evaluate both the economic and clinical impact of an intraven ous-fluconazole restriction policy in a university teaching hospital. METHODS: Intravenous fluconazole was restricted to patients unable to take oral medications due to significant nausea or to patients hose oral intake was restricted. A retrospective chart review and computerized record review was-conducted in patients receiving intravenous or oral fluconazole from J anuary 1 to June 30, 1997, and again from January 1 to June 30, 1998, after implementation of the policy. RESULTS: Six-month institutional expenditures for intravenous fluconazole d ecreased following policy implementation, from $81 900 to $45 400, an estim ated annual institutional savings ct $73 000. A 47% reduction in the, numbe r of patients treated with intravenous fluconazole was observed over the si x-month period after policy implementation. During this time, the rate of s uccessful clinical outcomes for documented or suspected disseminated Candid a albicans infection or febrile neutropenia remained the same (66.6% prepol icy and 65.9% postpolicy; p = 0.95) Similarly, the number of deaths in pati ents receiving fluconazole remained unchanged (p = 0.31). CONCLUSIONS: A restriction policy for intra successful outcomes or change i n mortality.