Eptifibatide Cost Containment/Waste Minimization Strategy

Abstract

Des Peres Hospital is a community teaching hospital that performs approximately 77 percutaneous coronary interventions (PCI) per month. Eptifibatide is the primary glycoprotein IIb/IIIa inhibitor used at Des Peres Hospital. The hospital spent approximately $340,598 on eptifibatide for use in the Cath Lab in 2003. A review was performed and found that patients were being dosed appropriately for the interventions performed. The Pharmacy was challenged to find a method to reduce the cost of this class of drug without adversely affecting patient outcomes. Further analysis revealed that the average patient needed approximately 207 mg of eptifibatide to initiate and complete the therapy, according to established dosing guidelines. We determined that a significant amount of eptifibatide was being wasted due to both the available dosage forms and the amount of fluid left in the intravenous tubing after therapy completion. An educational effort and the Eptifibatide Cost Containment/Waste Minimization Strategy was undertaken. Calculating the exact amount of drug needed for initiating and completing eptifibatide therapy following PCI now allows the Des Peres Hospital pharmacy to save approximately $34,188 per year by compounding a final infusion bag to be hung and flushed with normal saline. We describe our methods for doing such.