Analysis of amount, expenditures and indications of drug and blood product prescriptions at surgical intensive care units

Analysis of indication-related drug prescription patterns is of particular interest with regard to rising costs of the health service being also reflected in higher expenditures for drugs at the University Hospital of the Friedrich-Schiller-University Jena. This is especially important at ICU's, since treatments in patients with acute or chronic multiorgan failure are very expensive. Over a period of 4 months in 1994 the indication-related drug consumption of 2 surgical ICU's of the University of Jena has been recorded and analyzed using a notebook-PC. The total costs of these drugs and blood products, which caused 80% of total costs in the last year, came up to 1,144,773 DM for 465 patients. Nearly two thirds of the recorded expenditures were caused in patients with severe trauma or with acute bleeding. The 10 leading substances (antithrombin III, human albumin 20%, prothrombine complex, etc.) represent 67% of total costs including blood products, antibiotics/antimycotics and IgM enriched intravenous immunoglobulins. Therefore, the indications of these drugs in particular have been further investigated. During and after the study the results have been discussed with the treating medical staff leading to new therapy recommendations. Until the end of 1994 a remarkable cost saving could already be achieved for some drugs by more critical and purposeful use providing same high standard of medical treatment. Blood products have to be included into analyses of indication-related drug administration on the meaning of high costs, difficulties of accurate indication, and possibly undesired side-effects. However, medical and ethical aspects, e.g. minimizing of side-effects, have to take priority over pharmacoeconomical considerations especially in intensive care medicine.