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Reducing outpatient costs of nonsteroidal antiinflammatory drugs at a Department of Veterans Affairs teaching hospital.

OBJECTIVE
To determine how formulary changes, based on the recommendations of a clinical pharmacy specialist, affected outpatient nonsteroidal antiinflammatory drug (NSAID) prescribing patterns and drug costs in a Department of Veterans Affairs (VA) teaching hospital.


DESIGN
Cost-benefit analysis.


SETTING
VA teaching hospital.


PATIENTS
Outpatient veterans.


INTERVENTIONS
Sulindac, piroxicam, and diflunisal were removed from the formulary and made available only on a case-by-case review process. Buffered aspirin and phenylbutazone also were removed from the formulary; these drugs were made unavailable altogether. Ibuprofen, indomethacin, salsalate, enteric-coated aspirin, and plain aspirin retained their formulary status and were available for routine prescribing.


MAIN OUTCOME MEASURES
Changes in the number of prescriptions dispensed and in prescription costs for each NSAID were measured 3 months before and 5 and 21 months after implementation of formulary changes.


RESULTS
No prescriptions were dispensed for diflunisal, buffered aspirin, and phenylbutazone 21 months after implementation of the formulary changes. During this same period, prescriptions for sulindac and piroxicam declined 95.7 and 97.1 percent, respectively. The average cost per outpatient NSAID prescription declined from $14.78 to $4.75 (67.9 percent) after 21 months. An extrapolated yearly savings of $137,704 was calculated.


CONCLUSIONS
Formulary changes based on recommendations of a clinical pharmacy specialist resulted in altered physician prescribing patterns and reduced outpatient drug costs for NSAIDs in a VA teaching hospital.