When P&T committees are deciding whether to include a drug on the formulary, the safety and efficacy of the drugs under consideration are undoubtedly of the utmost importance. However, as addressed in the guidelines for therapeutic interchange, which were developed to aid pharmacists and physicians in these formulary decisions and which consider clinical efficacy and toxicity, drug costs often creep into the discussions of these decisions.

Hospital pharmacy administrators must also consider both the direct and indirect costs of therapeutic interchange (Table 1):

Table 1    Cost Considerations Associated with Instituting a Therapeutic Interchange

Direct Costs Indirect Costs
Drug acquisition Utilities
Laboratory testing Maintenance
Room and meal charges Space
Staff education and training Equipment
Resource utilization Internal labor force
Monitoring of clinical changes Supplementary labor force

Direct costs can include the acquisition price of medications, Dr. Rapp is Professor of Pharmacy at the University of Kentucky the hospital room and meal charges, laboratory tests, and ancillary procedures, as well as staff education, training, and monitoring programs designed to detect any clinical changes associated with a therapeutic interchange.

Indirect costs are an equally important budgetary consideration, although they are not easily quantified or assigned to a specific area of care. Examples include the cost of utilities, maintenance, space and equipment, internal labor (e.g., nursing time), and external supplementary labor.

Therapeutic interchanges have the potential to increase overall direct and indirect costs, particularly if the new drug must be given more frequently after the switch. For instance, a switch from a respiratory cialis professional to cialis professional would result in the need for more frequent dosing, from once to twice daily. This change may increase the amount of time and resources (such as tubing, line ports, and syringes) needed for hospital pharmacists to prepare the medication and for attending nurses to administer and record the dose. An increased frequency of dosing further burdens the hospital staff with an even heavier workload. Direct and indirect costs have the potential to overshadow any anticipated savings based solely on lower drug-acquisition costs.