(572) Clinical Evaluation and Economic Impact of Clevidipine at a Regional Community Hospital

Introduction: Clevidipine is an intravenous (IV) dihydropyridine calcium channel blocker (CCB) and selective vasodilator characterized by rapid onset and duration of action, making it useful in emergency management of blood pressure (BP). Due to its high lipid content, clevidipine use beyond 72 hours is not recommended and alternative anti-hypertensives should be initiated as there is minimal clinical experience beyond that time frame. Current literature suggests clevidipine may achieve goal BP faster, but the clinical impact is unclear as it has not shown differences in hospital length of stay or mortality. Compared to other IV anti-hypertensives, clevidipine is significantly more expensive. Given the lack of clinical superiority and increasing costs of clevidipine, this study evaluated current clevidipine utilization to identify cost savings opportunities.

Methods: This is a single-center, retrospective study evaluating adult patients on clevidipine between October 2022 and February 2023. The primary outcome was to assess clevidipine utilization trends. Secondary outcomes included identification of cost savings opportunities. Data is reported in median (IQR).

Results: Data for 155 patients is reported. The median age was 70 (56,81) years. The most common indications were ICH (55.4%), ischemic stroke (16.7%), and TBI (16.7%). Duration of infusion was 31.7 hr (9.8,88.3) with time to goal SBP of 22 min (13.3,48.5). Time to first oral anti-hypertensive was 21.3 hr (11.6,37.2). Number of oral anti-hypertensive classes while on clevidipine at 24 hr was 1 (0,2) and 48 hr was 1 (1,2) but remained at 2 (1,3) at 72, 96, and 120 hr. 37% of patients received intermittent IV as needed anti-hypertensives. Based on current utilization and average wholesale price of clevidipine, an estimated $625,000 is spent annually. Early initiation and optimization of multimodal anti-hypertensive therapy may reduce clevidipine duration and overall cost.

Conclusions: Clevidipine represents a significant financial burden and data is suggestive of overutilization. Considering its high cost and lack of clinical superiority, implementation of institutional guidelines to limit clevidipine use, promote alternatives such nicardipine, and optimize multimodal anti-hypertensive therapy may provide significant cost saving opportunities.