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Economic Impact of Amikacin Therapeutic Drug Monitoring (TDM) Service by Clinical Pharmacist in Bangkok Hospital Medical Center (BMC)

 
 
Authors
1. Sarakorn La-ongkaew Head of Clinical Pharmacy Department, Corresponding author
2. Kriangkrai Trakulpaisal Clinical Pharmacist 2
3. Anusara Yoosingha Clinical Pharmacist 2
4. Nattapol Malison Clinical Pharmacy Specialist Clinical Pharmacy Department, Pharmacy Division, Bangkok Hospital Medical Center
 
Acknowledgement
Dr.Kraisith Arya, Nephrologist at Bangkok Hospital Medical Center
 
Introduction
    Therapeutic drug monitoring (TDM) service in medications with narrow therapeutic range provided by clinical pharmacists at Bangkok Hospital Medical Center (BMC) is aim to minimize toxicity and maximize effectiveness. TDM in patients with high-risk of nephrotoxicity receiving Amikacin is crucial.
 
Objective
To calculate cost and cost saving of averting Amikacin nephrotoxicity in high-risk patients.
 
Method
All prevalence and cost data were obtained only from BMC. RIFLE criteria was used to detect nephrotoxicity from Amikacin. High-risk patients received Amikacin in 2013-2014 were used to evaluate economic impact of TDM service. Incidence of nephrotoxicity from Amikacin was obtained from 2009-2010. Cost was calculated based in 2014 with inflation rate of 2%. Cost of  Amikacin TDM service included two serum Amikacin measurements and cost of clinical pharmacist services. Cost of treatment if patients developed nephrotoxicity was calculated from cost of acute kidney injury (AKI) and chronic kidney disease (CKD) treatment. AKI patients were assumed to have 33.3% of possibility to progress to CKD. 
 
Results
Incidence of AKI from Amikacin in high risk patients in 2009-2010 was 26.3% (5/19). Incidence reduced to 0% in 2013-2014. Expected number of patients prevented from nephrotoxicity was 12/47patients in 2013 and 8/32 patients in 2014. Cost of Amikacin TDM service was 1,024.50 THB/patient. Cost of treatment if a patient developed nephrotoxicity was 7,914,868.00 THB/patient. Cost saving in terms of preventing nephrotoxicity by Amikacin TDM service was 54,690,914.56 THB. (Table 1)
 
Table 1: Cost-saving calculation of Amikacin TDM service and AKI treatment in 2013-2014
£Cost saving (AKI without CKD) = Cost of AKI (without CKD) treatment - Cost of TDM service 
¥Cost saving (AKI with CKD)     = Cost of AKI (with CKD) treatment - Cost of TDM service 
 
Conclusion
Amikacin TDM service reduced incidence of Amikacin nephrotoxicity and also was cost-saving for avoiding nephrotoxicity in high-risk patients.


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