QI Project 2021:

Cutting Healthcare Costs by Reducing IV

Acetaminophen Use
Acknowledgments:

Dr. Vazquez-Colon
Dr. Heitmiller
Dr. Cronin
 Introduction: Healthcare Costs
• United States was projected to spend $4.01 trillion on healthcare in 2020 (pre-COVID projections),
with estimated spending reaching $6.19 trillion in 2028 (19.7% US GDP).

• This amounts to approximately an average of $18,000 spent per person annually on healthcare.

• How does this affect our patients? A 2018 survey by West Health Institute and NORC at Univ. of
Chicago found that 40% Americans have foregone a recommended test or treatment in the last
year due to healthcare costs, 32% could not fill a prescription or received only a partial fill, and
30% reported struggling to pay for basic necessities such as food, heat, and housing due to
medical costs.

• Hospital care accounts for 33% of the nation’s healthcare costs. America’s costs for surgical
procedures compared to other countries – a typical angioplasty costs $6,390 in Netherlands,
$7,370 in Switzerland, and $32,230 in the United States.
 IV Acetaminophen in Pediatric Hospitals
• A 2019 study in JAMA Pediatrics studied the cost implications of using IV vs. PO/PR
acetaminophen in 34 U.S. free standing pediatric hospitals.

• Mean price difference for a 20kg child estimated at $0.02 (PO) vs. $0.66 (PR) vs. $13.51
(IV).

• At these 34 pediatric hospitals, acetaminophen costs increased from $2.2 million in

2010 (before IV acetaminophen was available) to $18.8 million in 2017.

• Several studies in pediatrics populations (adenotonsillectomies, pyloromyotomies,

various meta-analyses, etc) found that PO and PR acetaminophen were non-inferior to
IV acetaminophen administration.
 Project Development
• Initial goal: replace IV acetaminophen with preoperative or postoperative PO
acetaminophen in all surgical cases where patient could tolerate PO.

• More achievable, narrow goal: replace IV acetaminophen with postoperative PO

acetaminophen in adenoidectomy/tonsillectomy surgeries.
• Collect data regarding reduced costs associated with decreased IV acetaminophen use.
• Collect data regarding if there was a difference in postoperative opioid requirement in patients who
received IV vs PO acetaminophen
• Exclusion criteria considered (age, comorbidities/ASA classification, etc)

• Stakeholders: Anesthesia providers (attendings, AAs, fellows, residents), PACU nurses,

ENT surgeons, Pharmacy