Economic outcomes with the conversion of insulin delivery methods in hospitals

Abstract

Purpose: To evaluate the insulin wastage and associated acquisition costs when switching from individual patient supply (IPS) of 3-mL pens of rapid-acting insulin (RAI) aspart to floor stock (FS) dispensing of 3-mL vials of RAI lispro, and with conversion from IPS of 3-mL pens to centralized unit dose (CUD) of 10-mL vials of basal insulin detemir.

Methods: Data from September 2010 to December 2012 from three hospitals in the Roper St. Francis Healthcare (RSFH) were used: Roper Hospital (368 beds), Bon Secours St. Francis Hospital (204 beds), and Roper St. Francis Mt. Pleasant Hospital (85 beds). Insulin wastage and associated acquisition costs were estimated using regression models.

Results: The conversion from IPS of 3-mL pens of insulin aspart to FS of 3-mL vials of lispro was associated with a significant decrease in insulin wastage (204,042 IUs; p < .001) and equated to an average savings of $106.40 per patient at all three hospitals combined (p < .001). For basal insulin, conversion from IPS of 3-mL pens of insulin detemir to CUD of 10-mL vials was associated with a significant decrease in insulin wastage at Roper and St. Francis Hospitals (p < .001). For Mt. Pleasant Hospital, the decrease was not statistically significant. The predicted average reduction in insulin wastage per month was 52,542.9 IUs (p < .001) at all three hospitals combined.

Conclusions: Switching RAI from IPS of 3-mL pens of insulin aspart to one-time unit dose insulin lispro dispensed from FS 3-mL vials as needed significantly reduced insulin wastage and associated acquisition costs at the three combined hospitals. Conversion of basal insulin from IPS of 3-mL pens of insulin detemir to CUD of 10-mL vials of insulin detemir was associated with a significant reduction in insulin wastage and associated acquisition costs at three hospitals combined.

Keywords:

• Diabetes
• insulin
• individual patient supply
• floor stock
• centralized unit dose

Transparency

Declaration of funding

This study was funded by Eli Lilly and Company.

Declaration of financial/other interests

KK and SP are employees of Medical Decision Modeling Inc. MPN, HF, and XP are employees of Eli Lilly and Company. MPN and HF are also stockholders of Eli Lilly and Company. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors would like to acknowledge Laura Bean Warner for her assistance in the preparation of this manuscript.

Previous presentations

A sub-set of the results for rapid acting insulin was previously published as an abstract/poster at the ASHP 2015 Midyear Clinical Meeting. This manuscript contains a full report of the results for both rapid acting insulin and basal insulin.