The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

THE INCREASED COST OF TREATING PATIENTS WITH LEVALBUTEROL IS MORE THAN OFFSET BY A REDUCTION IN TREATMENT FREQUENCY AND ASSOCIATED LABOR COSTS.

Edward Amend BS, RRT, Bruce Burns, MA, RRT, RPFT, John Wolfe, RRT, CPFT Northern Colorado Medical Center, Greeley, CO.

Background: By substituting levalbuterol in place of racemic albuterol we reduced the average number of treatments per patient stay during March - May of 2005 by 22% compared to the same time period the year before. Levalbuterol is more expensive ($2.09 per dose) compared to albuterol ($0.31per dose) or albuterol and ipratropium ($0.46), but levalbuterol is typically administered Q8 hours (3 times per day) compared to four to six times per day for albuterol or albuterol and ipratropium. We wanted to determine if the increased cost of the drug was offset by decreased labor costs associated with a reduction in the number of treatments required per patient stay.

Method: During March through May of 2005, we initiated a protocol substituting levalbuterol at Q8 hour and Q4 PRN intervals in place of albuterol or albuterol with ipratropium at QID or Q4 hour intervals to adult in-patients receiving nebulized breathing treatments. Our substitution protocol and analysis excluded all ventilated, pediatric, and emergency department patients.

Results:
We experienced a 29% increase in the number of patients requiring nebulized breathing treatments during 2005 (956) compared to the same period in 2004 (741). Total projected savings for the study period ($103,939 - $92,169) was $11,770 utilizing the levalbuterol protocol.

  2004 study period 2005 PROJECTED without lev. 2005 ACTUAL with lev.
Drug cost $6,157 $7,881 $17,763
Total # of tx's 11,761 15,009 11,626
# of patients 741 956 956
Avg tx's per patient 15.7 15.7 12.2
Tx's x 16 min. 188,176 240,144 186,016
Labor hours 3,136 4,002 3,100
Labor costs @ 24/hr $75,270 $96,058 $74,400
Total costs $81,427 $103,939 $92,169

Conclusion: Instituting the levalbuterol protocol substantially decreased the average number of treatments per patient stay. The increased cost of using levalbuterol was more than offset by savings in labor costs. In addition, we did not have to recruit additional staff or use any agency workers to respond to the upsurge in census during the study period.

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