D0620 - The Price of Starting Docusate

Edward Bley, DO¹, Dae Kim, MMD¹, Elham Siddiqui, MD², Huma Ansari, MD¹, Tatiana Teslova, MD^2
1Albert Einstein Medical Center, Philadelphia, PA; ²Einstein Medical Center, Philadelphia, PA

Introduction: Docusate remains a commonly prescribed laxative in the hospital despite conclusive evidence displaying a lack of efficacy. This leads to directly harming patients when their constipation is inadequately treated or prevented. Additionally, this leads to unnecessary costs due to the cost-per-dose and administration costs. The aim of our study is to assess the cost of starting docusate as a new prescription on admitted patients. Our goal is to then use this data to support interventions leading to decreased docusate usage.

Methods: An Electronic Medical Record usage report of docusate and docusate-senna was generated from January 1st to April 21st. This timeframe was used to estimate yearly costs. This was further divided by department and floor to identify hotspots. This report only included patients who were started on docusate. For the cost analysis, a price of $0.04 was used for each docusate pill. As shown in prior studies, a time period of 45 seconds was used to estimate the time required for a nurse to administer the drug. Midpoint salary for nursing staff on most floors and units is listed on the hospital website at $38.59/hour. This was used to calculate nursing cost.

Results: A total of 7,808 new administrations of docusate were generated within our inclusion criteria with a total estimate of 25,610 administrations per year (Table 1). Administrations were highest on the general medical/surgical floor. At a price of $0.04, the annualized drug cost was estimated at $1,024.41. Given an estimated administration times and given average listed pay rates for nursing staff, this costs $12,353.74. In total, the cost of starting docusate in the hospital costs approximately $13,378.15 over the course of one year.

Discussion: In our single center cost analysis, we have shown that starting a patient on docusate, an ineffective medication, is associated with significant cost. Our estimation is not without limitation. This analysis did not include patients who were already on docusate as an outpatient. It also did not include the number of patients who continue receiving docusate after discharge. It also does not include patients with prolonged hospitalizations due to side effects from docusate or inadequate bowel regimen. Given these limitations, our final total of $13,378.15 likely only represents a small fraction of the actual cost of docusate. At a time of rising healthcare costs, it is imperative that hospital systems work to limit usage of docusate.



Disclosures:


Edward Bley, DO¹, Dae Kim, MMD¹, Elham Siddiqui, MD², Huma Ansari, MD¹, Tatiana Teslova, MD². D0620 - The Price of Starting Docusate, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.