A Cost Analysis of Salbutamol Administration by Metered-Dose Inhalers with Spacers versus Nebulization for Patients with Wheeze in the Pediatric Emergency Department: Evidence from Observational Data in Nova Scotia

Abstract

Background: Despite evidence demonstrating the advantages of metered-dose inhalers with spacers (MDI-s), nebulization (NEB) remains the primary method of asthma treatment in some pediatric emergency departments (PEDs). There is a perception that delivering salbutamol by MDI-s is more costly than by NEB. This research evaluates the relative costs of MDI-s and NEB using local, hospital-specific, patientlevel data. Methods: Regression models estimated associations between the salbutamol inhalation method and costs, length of stay (LOS) in the PED and hospital, and the probability of admission. Our population was a random sample of 822 patients presenting with wheeze to the PED in 2008/2009. Control variables included age, sex, triage acuity, time of PED visit, other medications, and vitals. Costs were calculated using the prices and quantities of medical resources used per treatment. Probabilistic sensitivity analysis was used. Results: Treatment with MDI-s versus NEB was associated with an absolute decrease in hospitalization of 4.4% (p < 0.05) and a 25-hour (p < 0.001) reduction in average inpatient stay, after controlling for triage acuity and patient characteristics. This resulted in savings of $24/patient in the PED and $180/ patient overall (p < 0.001). Inpatient care accounted for more than 90% of total patient costs. Conclusions: Our results suggest economic gains associated with MDI-s for salbutamol inhalation in PEDs. Sensitivity analyses show that this conclusion is not affected by changes in model parameters that may differ by jurisdiction. Since most facilities already collect the data used for this study, our methods could be adopted for a cross-jurisdictional account of the cost effectiveness of MDI-s.

Salbutamol and ipratropium by inhaler is superior to nebulizer in children with severe acute asthma exacerbation: Randomized clinical trial

“…The exacerbations account for the majority of asthma‐related costs and had a negative impact in the quality of life and education in children with asthma . Also, many studies showed that the use of MDIs with spacers instead of nebulizers to deliver beta‐2 agonist to treat children with mild‐to‐moderate asthma exacerbations in the ED could yield significant cost savings for hospitals and, by extension, to both the health care system and families of children with asthma …”

COVID-19: Time to embrace MDI+ valved-holding chambers!

“…Recent studies showed a significant cost saving with MDIs/VHCs because patients improved faster, were sent home more quickly, and could be taught in the emergency department to use the MDIs/ VHCs, thus decreasing early readmission. 4,5 VHCs have numerous additional advantages including an up to 80% decrease in the upper respiratory tract deposition of inhaled medication, and generation of significantly smaller particles that better penetrate into the lung periphery. 3 Furthermore, they are totally self-contained and do not require an external, expensive, and bulky source of energy.…”

A comparison of the costs of bronchodilator delivery methods in children with asthma exacerbations treated in hospital. The first Polish study in children

“…Research to date has shown that SABA as well as the combination of SABA and SAMA used in aerosol therapy of respiratory diseases may differ not only in the method of administration, but also in clinical effectiveness, safety and costs associated with their use in patients [3][4][5][6][7][8][9]. Research results indicate that regardless of the calculation method, the use of SABA with pMDI in combination with a valved holding chamber (VHC) instead of NEB is associated with a reduction in total costs in both the emergency department and the hospital ward [10][11][12][13][14][15]. There has been no similar analysis carried out in Poland.…”