MEDICATION COST SAVINGS AND COST AVOIDANCE FROM CLINICAL PHARMACIST-LED INTRAVENOUS-TO-ORAL CONVERSION IN POSTOPERATIVE SURGICAL PATIENTS AT A TERTIARY CANCER CENTRE IN A LOWER-MIDDLE-INCOME COUNTRY
Author(s)
Adeel Siddiqui, MPhil, PharmD1, Omar Akhlaq Bhutta, MPhil, MHA2, Saba Mazhar, MPhil2.
1Assistant Manager Pharmacy, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, 2Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.
1Assistant Manager Pharmacy, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, 2Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan.
OBJECTIVES: Intravenous (IV) to oral (PO) conversion of suitable medications reduces costs without compromising efficacy, but economic evidence from surgical settings in low- and middle-income countries (LMICs) is scarce. We quantified the medication cost savings and cost avoidance generated by a clinical pharmacist-led IV-to-PO conversion service in postoperative surgical inpatients at a tertiary cancer centre in Pakistan.
METHODS: Retrospective cross-sectional study (July 2023-June 2025) on the surgical floor of a tertiary cancer hospital, from the hospital perspective. Adult elective surgical inpatients with documented clinical pharmacist IV-to-PO switch recommendations were included. Cost saving per single dose (acquisition-cost difference between IV and oral formulations) and cumulative per-order cost avoidance until discharge (per-dose differential multiplied by IV doses avoided over the remaining stay) were derived from patient acquisition costs. Costs are reported in Pakistani rupees (PKR; 1 USD=280 PKR). Descriptive statistics were applied.
RESULTS: 641 IV-to-PO interventions were documented in 401 patients (65.1% female; mean age 43.2 years); 441 (68.8%) were accepted by physicians. Paracetamol (53.7%), metoclopramide (17.6%), omeprazole (13.7%), and tramadol (7.8%), all with established oral equivalents, were most frequently switched. Accepted interventions avoided approximately 1,870 IV doses (mean 4.2 per intervention). Cost saving per single dose was PKR 92,035 (USD 329); cumulative per-order cost avoidance until discharge was PKR 359,321 (USD 1,283). Monthly cost avoidance rose roughly four-fold from the first to the final six months, peaking at PKR 52,282 in December 2024. As estimates reflect acquisition costs only, the true economic impact is underestimated.
CONCLUSIONS: A clinical pharmacist-led IV-to-PO service generated consistent, scalable medication cost avoidance in a surgical oncology population in an LMIC, where medicines represent the largest component of out-of-pocket spending. These findings provide early real-world economic evidence supporting integration of clinical pharmacists into surgical care teams to optimise medication use and resource allocation in resource-limited settings.
METHODS: Retrospective cross-sectional study (July 2023-June 2025) on the surgical floor of a tertiary cancer hospital, from the hospital perspective. Adult elective surgical inpatients with documented clinical pharmacist IV-to-PO switch recommendations were included. Cost saving per single dose (acquisition-cost difference between IV and oral formulations) and cumulative per-order cost avoidance until discharge (per-dose differential multiplied by IV doses avoided over the remaining stay) were derived from patient acquisition costs. Costs are reported in Pakistani rupees (PKR; 1 USD=280 PKR). Descriptive statistics were applied.
RESULTS: 641 IV-to-PO interventions were documented in 401 patients (65.1% female; mean age 43.2 years); 441 (68.8%) were accepted by physicians. Paracetamol (53.7%), metoclopramide (17.6%), omeprazole (13.7%), and tramadol (7.8%), all with established oral equivalents, were most frequently switched. Accepted interventions avoided approximately 1,870 IV doses (mean 4.2 per intervention). Cost saving per single dose was PKR 92,035 (USD 329); cumulative per-order cost avoidance until discharge was PKR 359,321 (USD 1,283). Monthly cost avoidance rose roughly four-fold from the first to the final six months, peaking at PKR 52,282 in December 2024. As estimates reflect acquisition costs only, the true economic impact is underestimated.
CONCLUSIONS: A clinical pharmacist-led IV-to-PO service generated consistent, scalable medication cost avoidance in a surgical oncology population in an LMIC, where medicines represent the largest component of out-of-pocket spending. These findings provide early real-world economic evidence supporting integration of clinical pharmacists into surgical care teams to optimise medication use and resource allocation in resource-limited settings.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE514
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Study Approaches
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology, Surgery