(1365) Evaluating the Cost-Effectiveness of Transitioning Lacosamide Infusions to IV Push Administration

Introduction: Lacosamide is a Schedule V antiepileptic drug used for the treatment and prevention of focal onset seizures, primary generalized tonic-clonic seizures, and status epilepticus. While typically administered IV piggyback (IVPB) over 30-60 minutes, transitioning to IV push (IVP) administration can reduce drug, material, and labor costs, minimize the time to first dose, mitigate fluid shortages, and streamline workflow by eliminating compounding and delivery processes. Despite initial concerns for increased risk of adverse effects, studies have shown similar adverse effect profiles between IVPB and IVP administration. This study aims to assess the cost-effectiveness and time savings of transitioning from lacosamide IVPB to IVP administration.

Methods: A retrospective chart review was conducted on adult patients who received lacosamide IVPB during FY23, excluding those with incomplete data. The cost analysis compared the total expenses of lacosamide IVPB versus IVP. Time savings were evaluated by comparing the time within the medication use system and average administration times.

Results: A total of 120 patients were included, comprising 270 unique orders and 1329 doses of lacosamide infusions across 143 encounters. The pharmacy department would save approximately $4,923.42 annually, with additional soft savings from reduced compounding costs. Switching dispensing formulations would not only reduce the time to administer the first and subsequent doses by 50.41 minutes but also decrease the average administration time by 27.85 minutes, benefiting both pharmacy and nursing workflows. Additionally, it would save nursing staff time by storing the medication in an automated dispensing cabinet and eliminating the need to manage the infusion pump.

Conclusions: Given these results, the switch to IVP has since been approved at our institution. Transitioning from IVPB to IVP administration of lacosamide is safe, cost-effective, and time-saving. Due to the favorable safety profile and substantial cost and time savings, it is recommended to switch the dispensing formulation of lacosamide from IVPB to IVP.