(938) Vasopressin Utilization Trends and Cost Analysis in Septic Shock Patients

Introduction: Due to randomized controlled trials failing to demonstrate a mortality benefit of vasopressin in sepsis and the rising acquisition cost of vasopressin, our system restricted its use in septic shock patients during calendar year 2020, before eventually relaxing restriction oversight in January 2021. The objectives were to assess the effect of vasopressin restrictions on vasopressin utilization and perform a cost analysis of vasopressin utilization.

Methods: This was a retrospective analysis of adults with septic shock within a single health system including 15 hospitals, who received at least one vasopressor and an ICD-10 diagnosis of septic shock, admitted between 1/2020-10/2022. Patients admitted prior to 1/2021 were grouped into the “active” restriction cohort and after 1/2021 were the “non-active” cohort. The main objective was a comparison of vasopressin utilization and clinical outcomes between the two cohorts. Additionally, a cost-analysis was performed in the non-active cohort comparing patients that did and didn't receive vasopressin.

Results: 11,613 patients met inclusion criteria with 3780 (33%) in the active and 7833 (67%) in the non- active groups. The majority were admitted to a quaternary center with 51% and 48% in the active and non-active groups, respectively. There was an increase in vasopressin utilization in the non-active group (24% vs. 26%, p < 0.01), and an increase in vasopressin charges per day (0.76 vs. 0.84, p < 0.01). Mortality (43.6% vs. 46.7%, p < 0.01) increased in the non-active group, but use of RRT decreased (15% vs. 12%, p < 0.01). There was no difference in tachyarrhythmias (29.7% vs. 31%, p=0.16) between the active and non-active groups. The cost analysis included 7,889 patients with 26% of the cohort receiving vasopressin. Patients receiving vasopressin had an increase of total drug expenditures ($5,237 vss. $10,243 USD, p < 0.01) and more than doubling the total controllable costs ($8,142 v. $18,147 USD, p < 0.01). Vasopressin use was associated with increased drug expenditures (cost ratio: 1.8, 95% CI: 1.6- 2.0); interestingly, severity of illness lacked an association.

Conclusions: Vasopressin utilization increased with the removal of active oversight of restriction criteria. Patients receiving vasopressin had increased cost of care.