 |
|
A Review and Economic Evaluation of Bronchodilator Delivery Methods in Hospitalized Patients
Mark O. Turner, MD, CM;
Amiram Gafni, PhD;
Darlene Swan, RN;
J. Mark FitzGerald, MD
Arch Intern Med. 1996;156(18):2113-2118.
Abstract
| |
Background
Bronchodilator delivery by metered dose inhaler (MDI) to treat airflow obstruction is considered to be less expensive and as effective as nebulized therapy.
Objectives
To document the utilization of bronchodilator delivery methods in a tertiary care Canadian university teaching hospital and to perform an economic evaluation.
Methods
A prospective 6-week audit of 4 preselected hospital wards (respiratory, thoracic surgery, general surgery, and a general internal medicine clinical teaching unit) and a cost-minimization economic evaluation were performed. Bronchodilator (salbutamol and ipratropium bromide) doses, frequency, and delivery methods, either MDI or wet nebulizer (WN), were recorded for 95 patients treated with aerosolized bronchodilators. Direct costs for medications and hourly wages including benefits and equipment were obtained. Time and motion studies identified time allocated to MDI and WN delivery. We used sensitivity analyses to test assumptions that could significantly affect treatment costs, especially assumptions about medications, labor, and spacer devices. Costs are expressed in Canadian dollars (Can$1 = US$0.75).
Results
Sixty-seven patients (70.5%) were treated with WN, 6 (6.3%) with MDI, and 22 (23.2%) with both WN and MDI. Self-administration of salbutamol by MDI was the least expensive: $1.27 for 200-µg doses and $1.73 for 400-µg doses compared with $2.62 for a 2.5-mg dose delivered by WN. The difference in cost between equivalent treatments (400-µg MDI vs 2.5-mg WN) is only $0.89. Sensitivity analyses showed that MDI was the least expensive therapy when self-administration was possible and for all levels of supervision if more than 4 minutes was needed to administer a WN treatment.
Conclusions
Bronchodilator delivery by WN is commonly prescribed for hospitalized patients despite evidence for equivalency of effect using MDI and in the absence of substitution protocols. Previous studies have estimated a far greater cost differential based on unrealistic labor estimates. We found that supervision of patients using MDIs minimized the differential cost between WN and MDI therapy and that cost savings are maximal in patients who can self-administer MDI therapy. Methodologically sound economic evaluations can better identify true cost savings and variables that need further study.
Arch Intern Med. 1996;156:2113-2118
Author Affiliations
From the Department of Medicine, Respiratory Division, University of British Columbia, Vancouver (Drs Turner and FitzGerald and Ms Swan), and Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario (Dr Gafni).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Inhalation devices
CMAJ 2005;173:S39-S45.
FULL TEXT
Automatic replacement of albuterol nebulizer therapy by metered-dose inhaler and valved holding chamber
Hendeles et al.
Am J Health Syst Pharm 2005;62:1053-1061.
ABSTRACT
| FULL TEXT
Chronic obstructive pulmonary disease: the clinical management of an acute exacerbation
Hurst and Wedzicha
Postgrad. Med. J. 2004;80:497-505.
ABSTRACT
| FULL TEXT
Asthma Therapy: Metered-dose Inhalers Preferred for dose Infants and Toddlers
Paul and Randolph
AAP Grand Rounds 2003;9:49-50.
FULL TEXT
Nebulizers vs Metered-Dose Inhalers With Spacers for Bronchodilator Therapy to Treat Wheezing in Children Aged 2 to 24 Months in a Pediatric Emergency Department
Delgado et al.
Arch Pediatr Adolesc Med 2003;157:76-80.
ABSTRACT
| FULL TEXT
Teaching Time for Metered-Dose Inhalers in the Emergency Setting*
Numata et al.
Chest 2002;122:498-504.
ABSTRACT
| FULL TEXT
Is Nebulized Aerosol Treatment Necessary in the Pediatric Emergency Department?
Mandelberg et al.
Chest 2000;117:1309-1313.
ABSTRACT
| FULL TEXT
Inhalation devices and propellants
CMAJ 1999;161:s44-50.
FULL TEXT
Bronchodilator Delivery in Acute Airflow Obstruction: A Meta-analysis
Turner et al.
Arch Intern Med 1997;157:1736-1744.
ABSTRACT
|
