Critical analysis of common canister programs: a review of cross-functional considerations and health system economics

Abstract

Respiratory inhalers constitute a large percentage of hospital pharmacy expenditures. Metered-dose inhaler (MDI) canisters usually contain enough medication to last 2 to 4 weeks, while the average hospital stay for acute hospitalizations of respiratory illnesses is only 4–5 days. Hospital pharmacies are often unable to operationalize relabeling of inhalers at discharge to meet regulatory requirements. This dilemma produces drug wastage. The common canister (CC) approach is a method some hospitals implemented in an effort to minimize the costs associated with this issue. The CC program uses a shared inhaler, an individual one-way valve holding chamber, and a cleaning protocol. This approach has been the subject of considerable controversy. Proponents of the CC approach reported considerable cost savings to their institutions. Opponents of the CC approach are not convinced the benefits outweigh even a minimal risk of cross-contamination since adherence to protocols for hand washing and disinfection of the MDI device cannot be guaranteed to be 100% (pathogens from contaminated devices can enter the respiratory tract through inhalation). Other cost containment strategies, such as unit dose nebulizers, may be useful to realize similar reductions in pharmacy drug costs while minimizing the risks of nosocomial infections and their associated medical costs. The CC strategy may be appropriate for some hospital pharmacies that face budget constraints, but a full evaluation of the risks, benefits, and potential costs should guide those who make hospital policy decisions.

Keywords: :

• Chronic obstructive pulmonary disease
• Common canister
• Healthcare-associated pneumonia
• Metered-dose inhaler
• Nosocomial infection
• Nosocomial pneumonia

Transparency

Declaration of funding

Editorial and publication support for this commentary was funded by Sunovion Pharmaceuticals Inc.

Declaration of financial/other relationships

T.L., R.G., and D.P. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article. S.S. has disclosed that he has been a consultant to Sunovion Pharmaceuticals.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgments

Julie Crider PhD provided editorial assistance that was funded by Sunovion Pharmaceuticals Inc.