Implications of therapeutic drug monitoring

When appropriate, patients gain both medically and economically from therapeutic drug monitoring. Many reports in the literature indicate that therapeutic drug monitoring can decrease hospital stay and have important implications on the cost of medical care. Reduced drug-related toxicities are beneficial for patients and also diminish the liability of physicians. Ried et al. (5) evaluated the effectiveness of therapeutic drug monitoring in reducing toxic drug reactions by meta-analysis of 14 studies. The authors concluded that patients monitored for appropriate drugs suffered fewer toxic drug reactions than patients for whom therapeutic drug monitoring was not undertaken. Another study reported that determination of serum drug concentrations and evaluation of such results by clinical pharmacists resulted in significant cost savings (6). Crist et al. evaluated the impact of therapeutic drug monitoring of aminoglycoside (gentamicin or tobramycin) using 221 patients on the length of hospital stay, cost effectiveness, and related factors. The mean length of hospital stay was 8.4 days in the patient group that received individualized aminoglycoside doses (study group) versus 11.8 days in the control group. In addition, the hospital cost was lower by $725 per patient in the study group which would produce a savings of $640,000 at the author's institution (7).

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