Financial effect of converting ipratropium–albuterol therapy from inhalers to nebulizer treatments at an academic health system

Abstract

An automatic substitution of ipratropium-albuterol nebulization solution for MDIs resulted in a three-month savings of $99,359 in drug cost and an extrapolated full-year savings of $397,436. When additional costs associated with the substitution were taken into account, there was an overall savings of $146,806 during the implementation year and a projected savings of $257,936 for each following year.

Economic impact and chronic obstructive pulmonary disease outcomes of a comprehensive inhaler to nebulization therapy protocol implementation in a large multi-state healthcare system

“…However, they acknowledge that the actual impact on RT labor was possibly overestimated by their prediction by 31.6%. Although they deducted labor costs off total savings, the RT department was unable to quantify the actual percentage of FTE time allocated to the formulary substitution 24 .…”

“…Although most are poster presentations and abstracts, there have been numerous reports of implementing inhaler to nebulization protocols with success. These have shown significant cost savings, reduction of formulary medications stocked and reduction in the incidence of therapeutic duplications without incurring significant changes in RT labor, COPD LOS or COPD 30 day readmissions 6,8,[16][17][18][19][20][21][22][23][24] . Small studies also support similar protocols in mechanically ventilated long-term care and intensive care unit (ICU) patients suggesting no significant changes in ICU LOS, ventilator days, in-hospital mortality or ventilator-associated pneumonia (VAP) rates [25][26][27][28][29] .…”

Effect of a Nebulizer Holding Chamber on Aerosol Delivery

“…24 The Solo-holding chamber resulted in much better delivery than the Pro and the jet nebulizer or even the Solo itself with its T-piece. 5,25 These results might have occurred because the holding chamber studied was designed for the Solo, with which it gives maximum advantage.…”

Managing the Rising Costs and High Drug Expenditures in Critical Care Pharmacy Practice

“…One institution invested in these resources (nebulizer technology and respiratory therapy personnel), and even with these expenditures, they found significant cost savings in converting from albuterol/ipratropium MDIs to nebulizer therapy. 54 Estimated annual savings were $397,436 in direct drug costs and a projected $257,936 for each following year taking into account the initial investment in the program.…”

“…Limiting the ability of care providers to "override" non-critical care medications from automated dispensing cabinets may also be an area of operational control to pursue for medications with rising prices. One extreme measure proposed for low-volume very high-cost medications is to call care providers prior to every dispensed dose to ensure that medication 30,32 Prescribing protocol for an institution developed by a multidisciplinary group across all ICU settings Pharmacist-directed stewardship to enforce prescribing guidelines Use of oral a 2 -agonists to replace continuous-infusion dexmedetomidine Recombinant factor VIIa 37,40 Fixed-dosing protocol for warfarin-induced intracranial hemorrhage Implementation of pharmacist-driven critical bleeding management protocol Inhaled vasodilators 42,[45][46][47][48][49] Protocols regarding setup and weaning Substitution of inhaled prostacyclin Medications with relatively newer price increases Albuterol/ipratropium metered-dose inhaler 53,54 Switch to nebulizer products Minimize all inhaled bronchodilator use Chlorothiazide [56][57][58] Pharmacist stewardship program to enforce prescribing guidelines Substitution of oral adjunctive therapy for diuresis (e.g., metolazone) Nitroprusside [59][60][61] Substitution of nicardipine or clevidipine (branded products but are nonetheless cost saving) Vasopressors 62 Use of midodrine to reduce duration of vasopressor use ICU = intensive care unit.…”