Clevidipine and a cost-saving initiative for titratable intravenous antihypertensive agents

PURPOSE: This quality improvement initiative assessed the utilization of clevidipine (Cleviprex) in an institutional setting. The purpose was to identify cost-saving opportunities and implement strategies to promote cost-effective and clinically appropriate use of antihypertensive agents in various clinical scenarios. SUMMARY: This research was a single-center retrospective chart review of patients who received clevidipine from January 1 to August 31, 2023. Patients who were 18 years of age or older and had at least one documented clevidipine administration were included. In the patient population, 70% received clevidipine for a surgical hypertension indication and 30% received it for a medical hypertension indication. Only 18% of patients on clevidipine received concurrent antihypertensive agents, indicating that 82% of patients received clevidipine as first-line treatment. The results also showed significant medication waste when stocking 100-mL vials of clevidipine: less than 5 mL total was administered for 76.9% of the vials used in the operating room. In a cost comparison of the institution's titratable intravenous antihypertensives on formulary, the clevidipine 100-mL vial was the most expensive agent. A 2-phase approach to reduce medication waste and overall medication use was implemented. During phase 1, the clevidipine inventory was converted from 100-mL to 50-mL vials to reduce the amount of wasted medication. Order set revisions were carried out in phase 2 to create a guideline-directed, tiered approach to optimize antihypertensive medication therapy. CONCLUSION: A review of clevidipine utilization at the institution identified multiple strategies to reduce use, medication waste, and overall medication cost through appropriate use of intravenous antihypertensive agents.