Summary
Faced with a reduction in the 1990–91 pharmaceutical budget despite escalating prices, decisive cost-saving measures had to be implemented in our 1500-bed state-funded teaching hospital. 15 drug categories were reviewed by the Medicines Control Committee in conjunction with specialist work groups based on a detailed audit of the previous year’s pharmaceutical expenditure. The usage of medicines was rationalised by paying particular attention to expensive agents, substitution of less expensive alternatives, deletion of nonessential drugs from the formulary, restriction of certain medicines and by imposing fixed budgets.
65 items were deleted from the hospital formulary. The previous trend of an increase in annual expenditure was reversed during the 1990 to 1991 financial year; for the first time, it was less than the allocated budget. The 20 Pharmaceuticals making the greatest contribution to the drug bill comprised 31% of total expenditure in the 1989 to 1990 financial year and 26% in 1990–91 and declined from R7.4 million to R5.7 million during this period, a decrease of 23%. A decrease in expenditure was realised in 14 of the 15 categories reviewed. Overall a 20% saving, or R3.3 million, was achieved for these categories.
Similar content being viewed by others
References
Abramowitz PM. Controlling financial variables: changing prescribing patterns. American Journal of Hospital Pharmacy 41: 503–515, 1984
Baker JA, Lant AF, Sutters CA. Seventeen years’ experience of a voluntary based drug rationalisation programme in hospital. British Medical Journal 297: 465–469, 1988
Coleman RW, Rodondi LC, Kaubisch S, Granzella NB, O’Hanley PD. Cost effectiveness of prospective and continuous parenteral antibiotic control: experience at the Palo Alto Veterans Affairs Medical Center from 1987 to 1989. American Journal of Medicine 90: 439–444, 1991
Collier J, Foster J. Management of a restricted drugs policy in hospital: the first five years’ experience. Lancet 1(8424): 331–333, 1985
Editorial. Secretary of State limits range of prescribable NHS drugs. British Medical Journal 289: 1388–1389, 1984
Feely J, Chan R, Cocoman L. Impact of a hospital formulary on prescribing habits and drug costs. Irish Medical Journal 80: 286–288, 1987
Feely J, Chan R, Cocoman L, Mulpeter K, O’Connor P. Hospital formularies: need for continuous intervention. British Medical Journal 300: 28–30, 1990
First MR, Schroeder TJ, Alexander JW, Stephens GW, Weiskittel P, et al. Cyclosporine dose reduction by ketoconazole administration in renal transplant recipients. Transplantation 51: 365–370, 1991
First MR, Schroeder TJ, Weiskittel P, Myre SA, Alexander JW, et al. Concomitant administration of cyclosporin and ketoconazole in renal transplant recipients. Lancet 2: 1198–1201, 1989
Fowkes FGR. Doctor’s knowledge of the costs of medical care. Medical Education 19: 113–117, 1985
Frazier LM, Brown JT, Divine GW, Fleming GR, Philips NM. Can physician education lower the cost of prescription drugs? Annals of Internal Medicine 115: 116–121, 1991
Gibbins FJ, Sen I, Vaz FS, Bose S. Clinical budgeting and drug management on long-stay geriatric wards. Age and Ageing 17: 328–332, 1988
Harding JM, Modell M, Freudenberg S, MacGregor R, Nicolas Rea J. Prescribing: the power to set limits. British Medical Journal 290: 450–453, 1985
Kim JH, Gallis H. Observation on spiraling empiricism: its causes, allure and perils, with particular reference to antibiotic therapy. American Journal of Medicine 87: 210–206, 1989
Louis WJ. Regulatory demands for cost benefits. American Heart Journal 119: 771–775, 1990
Rowe J, Macvicar S. Doctors’ knowledge of the cost of common medications. Journal of Clinical and Hospital Pharmacy 11: 365–368, 1986
Ryan M, Yule B, Bond C, Taylor RJ. Scottish general practitioners’ attitudes and knowledge in respect of prescribing costs. British Medical Journal 300: 1316–1318, 1990
Schwartz WB, Mendelson DN. Hospital cost containment in the 1980s: hard lessons learned and prospects for the 1990s. New England Journal of Medicine 324: 1037–1042, 1991
Turner P. Local formularies and good patient care. British Medical Journal 288: 348, 1984
Woodward RS, Medoff G, Smith MD, Gray JL. Antibiotic cost savings from formulary restrictions and physician monitoring in a medical-school-affiliated hospital. American Journal of Medicine 83: 817–823, 1987
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Pillans, P.I., Conry, I. & Gie, B.E. Drug Cost Containment at a Large Teaching Hospital. Pharmacoeconomics 1, 377–382 (1992). https://doi.org/10.2165/00019053-199201050-00009
Published:
Issue Date:
DOI: https://doi.org/10.2165/00019053-199201050-00009