Impact of an Intravenous Fluconazole Restriction Policy on Patient Outcomes

Abstract

OBJECTIVE:

To evaluate both the economic and clinical impact of an intravenous 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 whose oral intake was restricted. A retrospective chart review and computerized record review was conducted in patients receiving intravenous or oral fluconazole from January 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 decreased following policy implementation, from $81 900 to $45 400, an estimated annual institutional savings of $73 000. A 47% reduction in the number of patients treated with intravenous fluconazole was observed over the six-month period after policy implementation. During this time, the rate of successful clinical outcomes for documented or suspected disseminated Candida albicansinfection or febrile neutropenia remained the same (66.6% prepolicy and 65.9% postpolicy; p = 0.95). Similarly, the number of deaths in patients receiving fluconazole remained unchanged (p = 0.31).

CONCLUSIONS:

A restriction policy for intravenous fluconazole results in significant cost savings, with no significant decrease in successful outcomes or change in mortality.