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Abstract：
Background: Hypercalcemia is a relatively common problem that may require hospital admission based on severity. A treatment option for hypercalcemia is calcitonin given intramuscularly or subcutaneously. Purpose: In 2015, calcitonin was on our health system formulary, but due to a sharp rise in cost, restrictions were placed to ensure appropriate utilization. Intervention: These restrictions reserved calcitonin for patients with symptomatic hypercalcemia or severe hypercalcemia, which was defined as an ionized calcium of greater than 1.5 mmol/L and/or total/corrected calcium (Ca) of greater than 13 mg/dL. In addition to providing criteria for its use, calcitonin orders also had an automatic stop date of 24 hours to ensure no more than 2 doses were provided in a 24-hour period. After the initial 24 hours, a patient would have to be reviewed again before any further doses were ordered and administered. If the patient met criteria, an additional 2 doses could be given in the next 24 hours for a total maximum treatment of 4 doses over a 48-hour time frame. Results: An evaluation to assess health system-wide compliance of the usage of calcitonin restrictions regarding utilization, effectiveness, and cost was conducted. In the 2-month study time frame that was examined, there was a decrease in 66 vials of calcitonin that were dispensed. This represents a 43% reduction in usage and an estimated US $450,000 reduction in the total money spent for calcitonin annually. No notable differences in Ca reduction were identified between the groups. Conclusion: This evaluation revealed that putting health system-wide restrictions in use for a high-cost medication can have a major financial impact without compromising clinical efficacy.
摘要：
背景：高钙血症是一个相对常见的问题，可能需要根据严重程度入院。高钙血症的治疗选择是肌内或皮下给予降钙素。目的：2015年，降钙素在我们的卫生系统处方集中，但是由于成本的急剧上升，限制是为了确保适当的利用。干预：这些限制为有症状的高钙血症或严重高钙血症患者保留降钙素，其被定义为大于1.5mmol/L的离子化钙和/或大于13mg/dL的总/校正钙(Ca)。除了提供其使用标准外，降钙素单的自动停止日期为24小时,以确保在24小时内提供不超过2剂.在最初的24小时后，在订购和施用任何进一步的剂量之前，必须再次检查患者。如果患者符合标准，可以在接下来的24小时内再给予2剂,在48小时的时间范围内总共最多治疗4剂.结果：评估全卫生系统对降钙素使用限制使用的依从性的评估，有效性,和成本进行了。在检查的2个月研究时间范围内，分配的66瓶降钙素减少。这表示使用量减少了43%,并且估计每年用于降钙素的总花费减少了450,000美元。在各组之间没有发现Ca减少的显著差异。结论：这项评估表明，将卫生系统范围内的限制用于高成本药物可以在不影响临床疗效的情况下产生重大的财务影响。
