Injection savings could mean better care in ICU

October 13, 2003

Intensive care doctors could cut the daily cost of care per patient by up to €64, and improve patient recovery simply by prescribing a different antibiotic or method of administering it. Research published in the latest issue of Critical Care assesses the hidden costs of administering intravenous antibiotics.

Quality of care and patient outcome in the ICU have both been linked to workload and staffing levels. Reducing the amount of time spent on administering intravenous antibiotics would allow healthcare workers to devote more time to other aspects of patient care. Such time savings would also cut hidden treatment costs, associated with staff time. For example, direct intravenous injection of antibiotics is time-consuming and requires highly qualified staff - adding a cost of over €8 per dose when compared to the most cost-effective method.

To assess the time commitment and other non-drug costs associated with intravenous antibiotics, researchers from The Netherlands used a costing method originally developed for analysing business administrative procedures.

"Gaining insight into all the factors that contribute to the actual total overall costs of drug therapy may help increase awareness into what actually drives the costs of hospital services and to identify opportunities for cost savings", say the researchers. "Total costs of intravenous antibiotic administration are formed not only by the costs of the drugs themselves but also, to a substantial degree, but the time expended by medical and nursing staff, costs of disposable materials and overhead costs."

The research team followed the treatment of fifty patients who were suffering from community acquired pneumonia or intra-abdominal infections. They used questionnaires and interviews to create a list of 103 routine tasks that were involved in administering intravenous antibiotics to these patients. By timing each procedure they calculated the costs of utilising medical and nursing staff. They also assessed the costs of the disposable materials as well as the drugs used.

The research team then compared the total costs of four different methods of intravenous antibiotic administration: by syringe pump, by volumetric pump, by direct intravenous injection and by 'piggyback' infusion. They also compared the costs related to the use of the six most widely used antibiotics.

When the drug costs were excluded, the cheapest method of administering intravenous antibiotics was with a syringe pump. This cost €3.23 per dose. Direct intravenous administration of antibiotics was the most expensive procedure, costing €11.69 per dose. The price difference was mainly because only the more highly paid certified nurses or physicians are able to perform direct intravenous administration, and the procedure requires slow infusion of the antibiotic.

The most expensive antibiotic to administer, out of the six tested, was Erythromycin. The total daily cost was €72.12 compared with €15.69 for Amoxicillin and €18.33 for Metronidazole. This price difference is primarily due to the relative insolubility of Erythromycin, which means it takes a long time to prepare - more than 35 minutes on average.

The researchers say, "The results of our study demonstrate that the administration of antibiotics is associated with significant hidden costs, which can in some cases exceed the costs of the antibiotics themselves." Antibiotics are the class of drugs most frequently given to intensive care unit (ICU) patients. With ICU costs today accounting for up to ten percent of overall hospital expenditure, cost reduction is an important issue in intensive care medicine.

Dr. van Zanten, the research team leader, says: "We hope that this study will lead to a new evaluation strategy of antibiotic costs. Often only drug acquisition costs are taken into account. Although more syringe pumps will be needed in hospitals, the total costs will be lower. And lowering workload for nurses and physicians may improve quality of care."
This press release is based on the following article:
Importance of non-drug costs of intravenous antibiotic therapy
Arthur RH van Zanten, Peter M Engelfriet, Karin van Dillen, Miriam van Veen, Mark JC Nuijten, Kees H Polderman
Critical Care 2003, 7:R184-R190

Upon publication, this article will be universally available online, without charge according to BioMed Central's open access policy. Please publish the URL in any news report so that your readers will be able to read the original paper.

For more details of the research, please contact the first author, Dr. Arthur van Zanten by phone on 31-318-437519 or by email at

For any other enquiries please contact Gemma Bradley by email at or by phone on 44-207-323-0323 x2331.

Critical Care ( is published by BioMed Central (, an independent online publishing house committed to providing immediate free access to peer-reviewed biological and medical research. This commitment is based on the view that open access to research is essential to the rapid and efficient communication of science. In addition to open-access original research, BioMed Central also publishes reviews and other subscription-based content.

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