Estimated cost-savings from optimizing use of inhaled medications for inpatients with obstructive lung disease

Abstract

Objective: The majority of hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD) misuse their inhalers. In a published program, “Nebs no More after 24,” the authors found their program to be effective at reducing unnecessary nebulized treatments, increasing patient education, and decreasing costs. The objective of this study was to develop financial models, both internal to our hospital and more generalizable externally, of the cost impact of transitioning adults hospitalized with asthma or COPD to metered dose inhalers (MDIs) after 24 h of scheduled nebulized medications (“nebs”), when appropriate, to help hospitals make cost-efficient decisions for inhaled medications.

Methods: “Internal” and “external” cost models were developed using number of patients, medication costs, and labor costs for nebulized medications and education for inhalers. Cost-savings were calculated by subtracting costs of nebulized-only cases from costs of nebulizer-plus-MDI cases. Estimates for staffing costs were obtained from the United States Bureau of Labor Statistics.

Results: Cost-savings were estimated at $12,136 or $20,783 in the internal model and $8,927 or $14,283 in the external model when 50% or 80% of patients transitioned from nebs to MDIs, respectively. The marginal cost saving for every additional five new patients (∼1% of n = 552) transitioning to MDIs was estimated at $187.50.

Conclusions

Models representing transitions from all-nebulized to nebulizer-plus-MDI respiratory medications resulted in cost savings, largely from the reduction of labor cost of nebulizer administration with nebs-only treatment. Therefore, transitioning from nebs to MDIs can lead to cost savings and could allow greater opportunities for inhaler education.

Keywords:

• High-value care
• self-management
• metered dose inhalers
• asthma
• COPD
• patient education

Acknowledgements

We would like to thank Sharon Markman and the Center for Healthcare Delivery Science and Innovation for their participation in and support for our Choosing Wisely project.

Declaration of interest statement

Dr. Press also discloses consultant fees from Vizient Inc and Humana. The other authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This work was funded by the Center for Healthcare Delivery Science and Innovation’s Choosing Wisely Challenge Award. Authors were supported by NIH funding: Press: NIH NHLBI R03 (HL144883) and R01 (HL146644); Arora: NIH NHLBI K24 (HL136859-03).