Budget impact analysis of conversion from intravenous to oral medication when clinically eligible for oral intake

Background: Many patients receive intravenous (IV) medication while clinically eligible for oral (PO) medication intake, which represents a potential for safety improvement and substantial medication cost reduction. Objective: We analyzed the potential hospital medication budget impact associated with converting from IV to PO administration of 4 targeted IV medications, each representing a different class of drug, when patients were clinically eligible for PO medication intake. Methods: Chlorothiazide, voriconazole, levetiracetam, and pantoprazole were identified as 4 costly IV medications with highly bioavailable PO equivalents. Data were extracted from the computerized provider order entry (CPOE) system at Johns Hopkins Hospital and analyzed to determine the doses administered of the 4 identified IV medications, while patients were concurrently receiving PO intake. Results: More than two thirds of adult inpatients were administered IV chlorothiazide, voriconazole, levetiracetam, or pantoprazole while concurrently receiving PO intake. This use of expensive IV medications rather than PO equivalents in patients eligible for PO medication intake added $1,166,759.70 to the yearly cost of care at Johns Hopkins Hospital. Conclusions: Efforts to remind physicians to convert patient orders from IV to PO medications in patients eligible for PO medication intake could have a considerable impact on the total cost of health care.