1996 OPEN FORUM Abstracts
ARE MDIs STILL COST-EFFECTIVE?
Michael McPeck RRT, Deniese S LeBlanc RRT and Gerald C Smaldone MD PhD. Departments of Respiratory Care and Medicine, University Hospital, SUNY at Stony Brook.
Compared to SVNs, MDIs are widely believed to be very cost-effective because of the reduced labor component associated with their use. However, in recent years, with the advent of TDPs, plus widespread use of spacers and single patient use peak flow meters (PFMs), overall cost comparisons between MDIs and SVNs should be reevaluated to account for these added incremental costs. The aim of this study was to compare therapy costs of the two devices in a population treated with a TDP. Methods: We analyzed data from 199 adult general medical patients treated by RCPs with an aerosol bronchodilator protocol that included conversion from SVN to MDI and adjustment of treatment frequency according to a severity score. Total treatments/patient plus cost of SVN or MDI w/spacer, PFM, drugs and labor were determined. Total accumulated costs for treatment by SVN/PFM only, or treatment by MDI/PFM only, were compared. Results: Of 199 consecutive patients enrolled in the TDP, 67 were immediately dropped from consideration of MDI conversion on the basis of technical factors. Of the remaining 132 patients, 109 (82.6%) were successfully converted from a SVN to an MDI as per protocol and received a median of 12 and a mean (SD) of 14.2 (10.6) treatments prior to discharge. The cost of the initial treatment for SVNs and MDIs was $12.60 and $30.19 respectively. However, the cumulative costs were essentially identical ($61.31 and $60.99, respectively) at the 8th treatment, Beyond the "crossover point" occurring at the 8th treatment, SVN therapy became progressively more costly than MDI, primarily as a function of the labor component. At the mean of 14.2 treatment/patient, for example, SVN cost was 15.2% higher than MDI cost ($103.08 vs $87.39). Conclusion: MDIs, despite the added costs of a spacer and PFM, were less costly than SVNs in our adult patients who received more than 8 treatments during their hospitalization. Total treatment costs by either device are sensitive to incremental costs of supplies and labor and can be managed accordingly. The "crossover point" analysis may provide different results in different patient populations, and with different combinations of supplies, drugs and personnel, and might therefore be a useful tool for aerosol therapy cost management.