In early March, most health care providers in the United States had never seen a patient with COVID-19. Six months later, nearly every emergency department and intensive care unit clinician in the country is all too familiar with the virus. During that time, they’ve learned a lot about how to best treat patients as new evidence emerges around medications and clinical protocols.
Vizient’s latest data insights brief, COVID-19: inpatient pharmacy utilization and outcomes reveals medication trends in the early months of the pandemic. The report, updated this month, examines inpatient utilization and outcomes for select medications considered as potential treatments in COVID-19 between April and July 2020.
“We knew we had an opportunity to really look at what has changed in clinical practice, specifically around COVID-19. So, we started publishing a series of short data insights briefs highlighting what we were seeing during the evolving pandemic, realizing that clinical practice was changing sometimes on a weekly basis,” says Dr. David Levine, Vizient group senior vice president, advanced analytics and product management.
Early Months Marked by Rapid Shifts in COVID-19 Treatments
In its pharmacy utilization insights brief, Vizient evaluated utilization and outcomes metrics for five COVID-19 treatments for all available hospitals in its Clinical Data Base (over 400). The five treatments examined in the brief are hydroxychloroquine, famotidine, dexamethasone, tocilizumab and remdesivir. The report highlights observed and expected length of stay, percentage of ICU cases, percentage of expected and observed deaths and other metrics for each treatment.
“Hydroxychloroquine was really thought to be the treatment of choice in the beginning of the pandemic, so its utilization was between 50 and 60 percent of cases in April. By July, it had decreased to next to nothing after it was shown not to be effective,” notes Levine. “It was encouraging to see how quickly medicine was able to pivot based on early results.”
Highlights from the April-to-July report’s findings:
- Cases using remdesivir and dexamethasone appear to be lower acuity or early intervention based on lower expected deaths and lower percentage of cases with ICU utilization and ventilation.
- Initial data indicates more favorable mortality rates in patients receiving remdesivir or dexamethasone, but further investigation is needed as more data becomes available.
- Increases in remdesivir and dexamethasone usage are seen between April and July 2020, which may be a result of shifting evidence and recommendations about their use in COVID-19.
- In April, hydroxychloroquine was the most utilized drug but by July, it was the least utilized after the FDA revoked its emergency use authorization.
- Famotidine is being utilized for side effects of other COVID treatments. It decreases gastric secretions, which are increased for people that are on ventilators as well as some of the drugs used for COVID that have gastrointestinal side effects.
The insights brief shows that tocilizumab, a newer drug, began gaining traction in April before decreasing slightly in May. While the data shows that patients on tocilizumab have worse outcomes than patients on some of the other treatments, this is most likely because tocilizumab seems to be reserved for the sickest patients. “It does seem that there is a benefit from the drug, but we definitely need more data,” adds Levine.
Levine is encouraged by the ongoing collaboration and sharing of emerging practices across health care. “It’s good to see that organizations are getting more selective and targeted in which drugs to use in which situations, meaning scientific knowledge has gotten out pretty quickly,” he says.
Anecdotally, Levine says the preliminary August data in the Clinical Data Base shows no significant shifts in COVID-19 treatment trends. He expects to publish a follow-up insights brief around the end of the year that analyzes COVID-19 treatments for the next few months. He and his team will also keep a close eye on how flu season impacts COVID-19. “As we enter flu season, we’ll also be monitoring whether the flu impacts the choice of therapeutics that hospitals are using to treat COVID-19 patients,” Levine says.
Clinical Data Base Brings Visibility and Clarity
The Vizient Clinical Data Base uses risk-adjusted methodologies and benchmarked outcomes data to help members measure quality and financial performance compared with other hospitals. It uncovers opportunities for performance improvement by combining risk-adjusted encounter data and line-item transaction details to show patient outcomes and utilization information.
“As soon as members submit their data, they are able to not only compare against themselves, but also against other hospitals and health systems,” says Levine. “There’s a strong culture of members sharing data around best practices in the clinical arena. It’s a wonderful community of improvement.”
As the pandemic evolves, Vizient continues to develop comprehensive resources for members, including COVID-19 insights briefs that use data from the Vizient Clinical Data Base. Reports on telemedicine use, elective procedures, health screenings and COVID-19 overall outcomes are just a few of the data insights briefs specific to COVID-19.