[AVBC 2025] Appropriate Creams Deprescribing: A Cost-Conscious Switch to Default Formulations
Care Process & Redesign
Appropriate & Value-based Care Conference
National University Health System
5 December 2025
To rationalise moisturising cream use through appropriate deprescribing and the introduction of a cost-effective default. A default switching strategy paired with targeted staff engagement led to a significant reduction in expensive moisturiser use without.
Year Submitted: 2025
Published Date: 05 December 2025
Tags: Care Process ＆ Redesign, Quality Improvement, Productivity, Cost Saving
About this Content
Aims
To rationalise moisturising cream use through appropriate deprescribing and the introduction of a cost-effective default formulation.
Background
Topical moisturising creams are commonly prescribed in inpatient settings for skin protection and dryness. However, wide variations in product type and cost can lead to unnecessary healthcare expenditure. At Alexandra Hospital (AH), an appropriate care initiative was launched to rationalise moisturising cream use through appropriate deprescribing and the introduction of a cost-effective default formulation.
Methods
The top 5 medications by cost in those 80yo was obtained. The appropriate care team identified 4,677 units of QV cream was prescribed in 2023 amounting to a cost of $40,643.13. There was no standardised prescribing pattern for topical moisturising cream. A hospital-wide briefing was conducted to raise awareness of high-cost prescribing patterns amongst medical, pharmacy and nursing staff. A default switch to aqueous cream, a clinically appropriate and cost-effective alternative, was introduced to the various wards in November 2024 and rolled out in the inpatient wards in December 2024. Monthly utilisation data were tracked from September 2024 to May 2025, including total volume issued and product-specific use.
Results
Overall cream usage remained stable, indicating continued clinical need. However, use of high-cost QV cream fell from 88.0% in September 2024 to 35.7% in May 2025, while aqueous cream use rose from 10.3% to 60.1% over the same period. Urea 10% cream remained low and stable. This presented a cumulative savings to patients of $22,998 over a 6-month period post-implementation.
Conclusion
A default switching strategy paired with targeted staff engagement led to a significant reduction in expensive moisturiser use without reducing total cream prescribing.
Lessons Learnt
The initiative demonstrates the feasibility and impact of deprescribing interventions in routine inpatient care.
Keywords
Deprescribing, Cost-effective, Moisturising cream, Healthcare expenditure
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | Alexandra Hospital |
Platform(s) | Appropriate & Value-based Care Conference |
Healthcare Professional Group(s) | Pharmacy |
Applicable Specialty or Discipline | General Medicine, Dermatology |
Project Lead(s) | Golda Z Wang |
Project Member(s) | Golda Z Wang |
Connect with this contributor!
Golda Z Wang - golda_wang@nuhs.edu.sg