The Science Journal of the American Association for Respiratory Care

2004 OPEN FORUM Abstracts

Common Canister Protocol vs. Individually supplied MDI’s at a 537 Bed Regional Center - a Pharmacoeconomic analysis.



Ehlers, Kathy BA RRT, Director of Respiratory Care, Albritton, Steve R. P. h., Director of Pharmacy Services, Stogner, Steven MD, Medical Director Respiratory Care, Forrest General Hospital, Hattiesburg, MS.


Background: Respiratory Therapy Departments have implemented the Common Canister Protocol (CCP) vs. individually supplied canisters as a cost saving measure for administering MDI therapy. Only modest published data is available to support the potential cost savings available from this treatment modality. The purpose of this study was the empirical measurement of actual cost savings, if any, attributable to the implementation of a CCP at a 537 bed medical center.

Methods:
In April of 2002 the Respiratory Therapy Department implemented a changeover from individual to common canister protocol using the Monaghan Medical
AeroChamber® Plus valved holding chamber (VHC). In September of 2003, 34 months of MDI units and cost data, representing equal periods pre and post CCP, was collected from The Answer System Morris and Dickson Drug Wholesaler purchase data and analyzed. All MDI medications available for use over the full pre/post analysis period including albuterol, Flovent, Combivent, Alupent, Tilade and Azmacort were studied. Results: Spreadsheet analysis of the units and price revealed a significant reduction in the number of canisters used pre and post conversion (4,506 vs. 1,880). Canister cost rose appreciably in the post conversion period with MDI cost increasing 20.3% (un-weighted) across all medications. To gain an equivalent cost basis for comparison, pre conversion MDI usage was adjusted to reflect the cost increase post conversion, and MDI expense for the two analysis periods was calculated as a built up model from each drug. Overall cost savings from conversion to CCP was $97,758.00 for the first 17 months or an estimated annual savings of approximately $69,000.00. (See Table 1)

      Table 1      
  MDI Units MDI Units MDI Units MDI Units Avg. MDI Cost
Medication Pre CCP Post CCP Change % Change Cost Savings
Albuterol (all) 1,885 1,117 -768 -40.7% $5.01 $3,849.36
Flovent (all) 745 181 -564 -75.7% 60.95 $34,375.80
Combivent 1,045 386 -659 -63.1% 40.81 $26,893.79
Alupent 30 4 -26 -86.7% 25.30 $657.80
Tilade 7 3 -4 -57.1% 36.62 $146.48
Azmacort 794 189 -605 -76.2% 52.62 $31,835.10
Total 4,506 1,880 -2,626 -58.3%   $97,758.33

Conclusions: Substantial cost savings resulted from the conversion to a CCP at this facility. No adverse effects have been reported. Although not specifically accounted for, the requirement to track and label individual patient canisters for discharge saved additional time and labor in both respiratory and pharmacy, and offers the potential to reduce discharge medication errors. While the success of a conversion to CCP will depend largely on the cost and mix of MDI medications, the savings realized in this study appear to offer hospitals an important pharmacoeconomic tool for reducing the cost of care while maintaining good clinical practice.