224. Cost Analysis of a Significant Decrease in Vancomycin Use as a Result of an Antimicrobial Stewardship Intervention

Abstract

BackgroundA previous pre–post quasi-experimental study performed at an academic medical center assessed benefits of daily stewardship review with and without rapid diagnostic technology (RDT). The study found no difference in time to effective antibiotic therapy when comparing daily stewardship review to RDT and historical control groups. However, vancomycin duration of therapy significantly decreased with daily stewardship review compared with control (31.8 vs. 66 hours, P < 0.001). Subsequent elimination of this RDT saved the institution $53,000 in annual costs. However, the effect of the decrease in vancomycin use on this institution’s annual costs is unknown.MethodsThe purpose of the present study is to determine the difference in institutional costs associated with vancomycin after implementation of a stewardship intervention. A retrospective cost analysis was performed which included hospitalized adults on vancomcyin for positive blood cultures from June to October 2014 (preintervention) and June to October 2015 (postintervention). The primary outcome was the amount of institutional cost saved, including drug, phlebotomy, laboratory, nursing, and pharmacy costs. Secondary outcomes included vancomycin DOT/1,000 patient-days, nephrotoxicity, in-hospital mortality, and length of stay.ResultsInstitutional cost savings associated with vancomycin over 5 months amounted to $2,900 for an extrapolated cost savings of $6,960 per year. Although this cost savings was minimal, there were decreases in each individual vancomycin cost component. Drug acquisition was associated with the largest cost reduction represented by a 26% decline. Next, phlebotomy and laboratory costs each decreased by 24%, while nursing and pharmacy costs decreased by 7% and 4%, respectively. There were no differences in vancomycin DOT/1,000 patient-days, nephrotoxicity, in-hospital mortality, or length of stay.ConclusionVancomycin is associated with many hidden ancillary costs, and pharmacy and nursing labor remain substantial despite a reduction in its use. The tracking of antimicrobial stewardship actions is highly recommended; however, more research is needed to determine the optimal process for a vancomycin cost analysis.Disclosures All authors: No reported disclosures.