The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

COST EFFECTIVENESS OF LEVALBUTEROL VS RACEMIC ALBUTEROL

Karen Sicard AS RRT, Steve Hilton BS RRT, Melissa Staie BS RRT, WellStar Health System, Marietta GA; Anuradha Thopu MD, Northwest Georgia Pulmonary consultants, P.C.

Background: With the shortage of Respiratory Therapists and the increase of service areas at WellStar, Respiratory Care needed to investigate delivery of alternate nebulized medication therapy that would be cost effective while delivering best practice for our patients.

Method: WellStar Information System and chart review were used to collect and extract data on the pilot group and the retrospect group of patients during December 15 to February 28 (2003 and 2004 respectively) at our 98-bed Douglas Hospital. The pilot group consisted of 47 patients with a diagnosis of COPD, Asthma and Simple Pneumonia (S. Pneumonia) receiving 1.25mg levalbuterol nebulizer therapy. The retrospective group consisted of 44 patients of the same diagnosis receiving 0.5mg of racemic albuterol nebulized therapy. Financial impact was determined by the cost of drug, equipment and labor. Equipment cost was calculated by nebulizer cost every seven-days. Drug cost was the average cost of unit dose medication delivered for each group. Labor cost was derived using the AARC 2004 Uniform Reporting Manual for Acute Care Hospitals and the average salary for a Respiratory Therapist (15.47 mean minutes/nebulized treatment and $21.00/hr salary cost). Thirty-day readmission for the same diagnosis and the patients admission and discharge peak flows, FEV1 and FEV6 were measured for the pilot group's outcome.

Results: The pilot group showed an overall decrease of 265 nebulized treatments delivered with a 34% decrease in the average number of treatments per admission case. Each diagnosis group revealed a significant decrease in therapy with a decrease in the ALOS (table 1). Patient outcomes for the three diagnosis groups receiving 1.25mg levalbuterol showed improved PEFR and FEV6 in the patients with obstructive air flow with no adverse effect. There were 25% less 30-day readmission for the same diagnosis in the pilot group.

Table 1. Decrease in services per admission cases

  Nebulizer Rx ALOS/days
COPD 9.4 1.1
Asthma 6.7 1.3
S. Pneumonia 6.5 0.1

Conclusion: There is a potential cost decrease of $11,572.00 annually for these patient types. Based on the findings the use of Levalbuterol nebulization with a Q6 or Q8 hr frequency provides positive patient outcomes while not increasing the ALOS or readmission rate. Levalbuterol appears to be an efficient alternative therapy and an opportunity to improve compliance and reduction in both medical and billing errors as discussed in the AARC White Paper on Concurrent Therapy.

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