Remdesivir Stewardship Reduces Hospital Stay Duration of COVID-19 Patients

In hospitalized COVID-19 patients, remdesivir stewardship reduced hospital length of stay and therapy duration.

Remdesivir is the standard of care to treat patients hospitalized with COVID-19. The treatment, developed by Gilead Sciences, targets the viral RNA polymerase, allowing it to remain effective against all COVID-19 variants of concern.

Particularly in patients receiving low flow oxygen, remdesivir has significantly shortened recovery time. However, one study, accepted as an abstract at this week’s Making a Difference in Infectious Diseases (MAD-ID) 2022 Annual Meeting, raised concerns over the high cost of the therapy.

A 5-day course of remdesivir costs $3120 per patient. This cost was originally seen as reasonable, given arguments that remdesivir would save an estimated 12000 per patient by shortening hospital stays by 4 days. However, hospitals have not seen this drastic reduction in length of stay in remdesivir patients. This study reviewed remdesivir orders to understand whether the treatment significantly and justifiably reduces hospital costs and length of stay.

The single-center, retrospective, comparative study was conducted at AdventHealth Orlando, a 1368-bed teaching hospital in Florida. In January 2021, campus-level infectious diseases pharmacy specialists, the directory of pharmacy, and the chief medical officer designed a remdesivir stewardship strategy. The plan included targeted education and escalation of orders that did not meet institutional criteria at the time of order verification.

This study assessed whether the pharmacist-driven remdesivir stewardship initiative reduced the duration of therapy in hospitalized COVID-19 patients. The investigators compared pre-stewardship patients, who received remdesivir from December 1, 2020-January 7, 2021, to post-stewardship patients, who received remdesivir from January 8-February 28, 2021.

A total of 2104 remdesivir orders were included in the analysis, 209 pre-stewardship and 1895 post-stewardship initiative. The average patient age was 59 years, and the cohort was 51% female. In both the pre- and post-intervention groups, the majority of patients required low flow supplemental oxygen at the time they started remdesivir.

In the post-stewardship group, there were significantly more remdesivir orders that aligned with institutional criteria. Additionally, fewer patients in the post-stewardship group completed the full 5-day course of remdesivir. This finding was significant because a preliminary review of remdesivir treatment at AdventHealth Orlando found COVID-19 patients who were ready for discharge were delayed unnecessarily to finish the 5-day therapy.

The investigators concluded that the pharmacist-driven initiative improved adherence to the institutional algorithm. Remdesivir stewardship reduced hospital length of stay and therapy duration.

This study, “Remdesperate for Stewardship: Impact of a Remdesivir Stewardship Strategy on the Care of Patients with COVID-19 Admitted to a Community Teaching Hospital,” was accepted as an abstract for the Making a Difference in Infectious Diseases (MAD-ID) 2022 Annual Meeting.