With the continued rising costs of health care and decreased reimbursements by payers, hospitals are constantly pressured to adopt strategies intended to decrease overall costs. These cost-reducing strategies commonly involve the hospital’s pharmacy and may include formulary management, the use of generic substitutions, and membership in a large purchasing group.
Therapeutic interchange is a widely used option that substitutes less expensive agents within the same pharmacological class. However, decisions on therapeutic interchange must take into account the overall characteristics of each drug in addition to drug-acquisition costs. In the past, the availability of inexpensive generic agents often led hospital P&T committees to consider switching to these agents as the preferred drugs. However, when a therapeutic interchange is implemented, it is important to consider direct and indirect costs that can affect other aspects of the hospital system.
With the class of antibiotics, the availability of generic intravenous (IV) (Cipro canadian, Bayer) can provide an opportunity for P&T committees to consider using this agent as the primary fluoroquinolone for certain bacterial infections. However, ciprofloxacin drug is not therapeutically identical to the respiratory fluoroquinolones, such as (Levaquin generic, PriCara), (Bayer), and gemi-floxacin mesylate (Factive, Oscient), and it is not recommended for the treatment of some respiratory tract infections.
A therapeutic interchange involving the fluoroquinolones should take into account drug-specific attributes such as pathogen coverage, dosing frequency, resistance development, and the potential for collateral damage, which can significantly affect overall health care costs. Therefore, a careful analysis is required when assessing the possibility of substituting a fluoroquinolone on a formulary.