Cost-Effective and Sustainable Drug Use in Hospitals: A Systematic and Practice-Based Approach

Michiel Zietse (), Shannon L. Zeeuw, Anne-Sophie Klein Gebbink, Annemarie C. Vries, Marie-Rose B. S. Crombag, Roelof W. F. Leeuwen and Maaike J. Hoedemakers
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Michiel Zietse: Erasmus University Medical Center
Shannon L. Zeeuw: Erasmus University Medical Center
Anne-Sophie Klein Gebbink: Erasmus University Medical Center
Annemarie C. Vries: Erasmus MC University Medical Center
Marie-Rose B. S. Crombag: Erasmus University Medical Center
Roelof W. F. Leeuwen: Erasmus University Medical Center
Maaike J. Hoedemakers: Erasmus University Medical Center

Applied Health Economics and Health Policy, 2025, vol. 23, issue 2, No 3, 183-195

Abstract: Abstract Background and Objective Rising healthcare costs challenge the financial sustainability of healthcare systems. Interventional pharmacoeconomics has emerged as a vital discipline to improve the cost-effective and sustainable use of drugs in clinical practice. However, current efforts are often fragmented, highlighting the need for an integrated hospital-wide approach. This study aimed to develop a scalable framework to systematically identify and implement cost-effective and sustainable drug use practices in hospitals. Methods This study was conducted at the Erasmus University Medical Centre in Rotterdam between December 2022 and July 2023. A novel ‘8-Step Efficiency Model’ was designed to systematically identify and evaluate strategies for cost-effective and sustainable drug use. The process involved identifying high-expenditure drugs, systematically assessing these drugs using the Efficiency Model, and conducting a multi-disciplinary evaluation of the proposed cost-effectiveness strategies. Results The study assessed 39 high-cost drugs, representing 57% of the Dutch national expensive drug expenditure in 2021. Initiatives for enhancing cost-effectiveness and sustainability were identified or developed for 27 out of the 39 assessed drugs (51% of the national drug expenditure in 2021). Case examples of infliximab (e.g., wastage prevention) and intravenous immunoglobulins (e.g., lean body weight dosing) illustrate practical applications of the framework, resulting in substantial cost savings and improved sustainability. Conclusions This study presents a systematic scalable model for enhancing the cost-effectiveness of high-expenditure drugs in hospital settings. This approach not only addresses financial sustainability but also promotes the quality of patient care and sustainable drug use. This model could serve as a generic blueprint for other institutions to identify and implement cost-effective and sustainable drug use strategies.

Date: 2025
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DOI: 10.1007/s40258-024-00937-6

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