Computer Methods and Programs in Biomedicine 46 (1995) 13-21

ea iotic cost calculator; an exp antibiotic cost calculation

Department of Bacterioiopy, Beelfasst Ciry Hospital, Lisburn Road, Belfast BT9 7AD, Northern Ireland, UK

Received 18 May 1994; revision received 13 July 1994; acceped 28 July 1994

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AtHract

An application to cost antibiotic therapy was developed using Object Vision, an object-oriented software develop- ment program. The application facilitates calculation of the cost of up to six antibiotics (three oral and three intrave- nous) in terms of acquisition, delivery, laboratory and complication components. The application consists of two files. The first file allows entry of basic cost data. The second tile allows the user to define each antibiotic regimen and the management, and thus the cost, of complications relevant to the antibiotics being costed; costs are automatically calculated and displayed. The program also contains a help system; this comprises extensive explanation of each stage of the calculation process, a summary of recent literature on the percentage incidence of complications for commonly used antibiotics, and a bibliography. The summary and bibliography may be printed. The program is designed for use by hospitals, universities and pharmaceutical companies for calculation of total in-patient charges, marketing and re- search. It is a user-friendly system which dramatically reduces the inherent complexities of this area of medicine.

Keyworrls: Antibiotic; Drug; Cost; Computer

ealth care cost containment is a recurring e throughout the world and pharmacy costs

are particularly vulnerable as targets for ration- ahsation. Antibiotics, which comprise an ap- preciable fraction of hospital pharmaceutical

ase expense, have become prominent in rations toward cost reduction. The acquisi-

tion cost (first order analysis) of an antibiotic is only one of four quantifiable cost elements which together account for the total cost of antibiotic therapy [1,2]. The other elements are antibiotic

preparation and delivery (second order an~~y§~s), laboratory costs (third order analysis), and com- plication costs (fourth order analysis).

Calculation of global antibiotic costs is very complex, as each variable may take any of a range of values depending on choices made as to the therapeutic regimen. For this reason, com~uterisa- tion is appropriate. Several computerised systems have been developed for this purpose [S-6]; how- ever, none is particularly user-friendly an one, developed by Gladen [5], permits fourth order analysis; however, to achieve an accurate assessment of complication costs in this program5

Q~6~-26~~/~~/$~9.50 0 1995 Elsevier Science Ireland Ltd. All rights reserved SSDI 0169-2607(94)01592-4

24 J. Kerr/Comput. Methods hogrnms Biomed. 46 (1995) 13-21

rior to using the program, gement costs of various com-

lications. These costs are then entered into the uter ~~~~~~at~o~s as totals. This is time con-

suming and users may not be sufficiently ex- perienced for this task. For this reason, the

ntibiotic Cost Calculator was developed. The ntibiotie Cost Calculator assesses the cost of up

to six ~~t~bioti~s (three oral and three intravenous) s of acquisition, delivery, laboratory, and ation components. It is a user-friendly sys-

m which dramatically reduces the inherent pro- ems of this complex area of medicine.

The Autib~oti~ Cost Calculator was developed an object-oriented software

ent program, running within MS Win- operating system. The hardware used was

a 80486 DE33 personal compu- M. The system was designed to

ectives: antibiotic cost cal- culation, basic cost data storage, a facility for spe~i~~~tio~ of the therapeutic management strat- egy for I2 antibiotic-related complications, and a help system. The help system comprises an exten- sive ex~tlanatio~ of each stage of the calculation process, a summary of recent literature on the per-

ideate of complications for commonly otics, and a bibliography. ram consists of two files. The first file,

Center.ovd, facilitates entry of basic cost data antibiotics, consumables, labour, procedure

and hotel costs. The second file, ACC.ovd, com- prises cost calculation mechanism, help sys- tem, a bibliography. The program takes the form of a series of “forms’ in a ‘stack’. A form is reminiscent of a paper form, containing fields. Each field contains a value which is either user- entered or ~al~~~lated from values in other fields in

e application by a formula specified by the pro- am author. Each field has a name which may or

may not be hidden. from the user; this name is used in 6a~~u~atio~ formulae. Each field may have a

hi& is the means by which its value Each field may also have an ‘event ten-nines the action consequent upon

selecting or ~~s~~e~ting the field, or changing its

value. The user is given the op~ort~~~ty to cost u to six antibiotics in one ~a~~~~~tio~ cycle: three oral and three intravenous. By specifying wbetb~r the calculation is intende for ‘one ~atie~t9 or as a ‘cost comparison’ at th start of tbe ~a~~~lat~o~ process, the user may either calculate total antibi- otic costs for one patient, or ~erfo~ a cost corn- parison of two or more different r~girne~s*

sic cost data ~~co~poratio~ t Vision@ is capable of creating data

files in five diffe store basic cost the Antibiotic Cost basic cost data of oral antibiotics. tains basic cost data on intrave The third contains basic consu laboratory test costs for use in

basic consuma ts for use in foirth order analy

number of antibiotics and entered by the user. The seco limited to one cost for each specn

one country to the next, the program user to specify the currency at the stage o

the user in the calculation file. The ACCenter.ovd file and the ACC.ovd file are

each separately linked to each of these databases. Basic costs may be entered or cha via the ACCenter file but may only be ~~~e~se calculation or viewed from the A file. The user is given the opportunity to view b costs for sec- ond, third and fourth order analysis at ap

nts during the calculation process as these ts may have a bearing on $~b~eq~e~t deci

made by the user.

To enable the incorporation of corn~~i~atio~ costs and as the management of various ~~tib~~t~~- related complications varies widely from one cen- tre to another, the user is given the ~~~ortu~it~ to define the management of each of 1 tions which may be related to an

J. Kerr / Cornput. Methods Programs Biomed. 46 (1995) 13-21

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Fig. 1. Introduction.

Fig. 2. First order anaiysis.

I6 J. Kerr / Comput. Methods Programs Biomed. 46 (IWS) 13-21

r,

Fig. 3. Second order anatysis.

Fig. 4. Second order analysis - intravenous access.

J. Kerr / Comput. Methods Programs Biomed. 46 (i93.5) 13-21

Fig. 5. Third order analysis.

Fig. 6. Introduction to fourth order analysis.

9. Kerr / Cornput. Methods Programs Biomed. 46 (1995) 13-21

Fig. 7. Management of complications - I.

Fig. 8. Management of’ complications - 2

J. Kerr / Comput. Mehods Programs Biomed. 46 (199.5) 63-21

Fig. 9. Management of complications - 3.

Fig. 10. Duration of an average antibiotic course.

20 J. Kerr /Cornput. Methods Programs Biomed. 46 (1995,J 13-11

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-7.I.z I. I”. . “‘W’J”’ ,“. “.F ..-WV._.. r---J

“,. ““““... ,.“,” --.- “.“” -... :-“‘ ‘.

‘., ;:

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Fig. 11. Fourth order analysis.

Fig. 12. Summary of costs.

J. Kerr / Comput. Methods Programs Biomed. 46 (1993) 13-21 21

rotoxicity, cochleotoxicity, vestibulotoxicity, bleedi~~coa~lation, bone marrow

depressions diarrhoea, pseudomembranous colitis, rash, psendocbolelithiasis, superinfection and hep- atotoxicity. In the case of, for example, nephrotox- icity, the user is asked for the number of intensive care days, routine care days, nephrology consulta- tions, days of haemodialysis, days of peritoneal di- alysis, and measurements of full blood count, urea and electrolytes, and creatinine clearance involved in the management of one typical case. The com- ponent costs of each complication will obviously be different. Therefore, in the program, the com- ponents of each complication are tailored to reflect its management. Published research on the man- agement of antibiotic-related complications is sparse and so this area of the program was design- ed to acco~odate a wide range of differing man- agement strategies for each complication.

As the management of each of these complica- tions is specified by the user, the cost of each man- agement strategy is calculated. The user is then asked for the duration of an average course of ~nt~biotics~ this is required for calculation of the cost per day of each antibiotic-related complica- tion Once this is obtained, the user is given the op- portunity to specify the percentage incidence of each complication for each antibiotic to be costed. At this stage the review of published literature on percentage incidence of toxicity may be viewed for assistance by clicking an action button.

The ACC program file starts with an introduc- tory form containing a ‘begin’ action button. Sub- sequent forms guide the user through first, second, third, and fourth order calculations (Figs. 1-12). The user has the option of printing the summary and the bibliography.

. ~~~~lu~i~~

As awareness of the need for accurate assess- ment of the hidden costs of antibiotic therapy in- creases, hospital, university and pharmaceutical

company departments concerned with cost con- tainment will look for a valid mea cost calculation. The present sy manageable, user-friendly and flex requirements for the program are a computer with 4 Mb RAM. Softwa for the program are MS DOS and 3.1@.

Antibiotics vary widely in both total a ponent costs. For example, some antibiot as gentamicin, are relatively inexpensive to chase, but are expensive to use thera~euti In contrast, other antibiotics, such as third genera- tion cephalosporins, are relatively ex~e~lsive to purchase but inexpensive to use therapeutically. A cost analysis is made more accurate, and thc~~f~re more meaningful, as more are considered. Therefore, antibiotic formularies, marketi in-patient charges and resear curate as possible. This computer program is ultimately flexible and may be used in any of the above areas. It is extremely u§er-friendly, an easily be managed by a person i~~~pe~i~~ced with computers.

References

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J.R. Kerr, J.G. Barr, E.T.M. Smyth and J. O’Hare, Tech- nique for calculation of the true costs of antibiotic thera- py, Eur. J. Clin. Microbial. Infect. is. I1 (1992) 823-827. H.E. Gladen, Cost-effective aminoglycoside therapy in the surgical patient. Am. J. Med. gO(suppl. 6B) (1986) 228-233, M.D. Parr, LA. Hansen, W.W. Waite and R.P. Computer program for comparing tot.aI costs for intrave- nous antibiotic regimens. Am. J. Pha~acoi. 43 (19%) 2189-2192. D. Day, Microbiology and the Cost of Antibiotics, (Scientific exhibit presented at the American Society of Hospital Pharmacists Annual Meeting, Reno, Nevada, USA). H.E. Gladen, Computer modelling antibiotic therapy costs: impact of therapeutic range. Drugs 35(Suppl. 2) 208-213. J.R. Kerr, J.G. Barr and E.T.M. Smyth, Computerisa- tion of the calculation of true antibiotic costs. Eur. J. Clin. Microbial. Infect. Dis. 12 (1993) 622-625.