The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

CLINICAL AND ECONOMIC OUTCOMES WITH A CONVERSION TO ARFORMOTEROL ONCE OR TWICE DAILY FROM LEVALBUTEROL USING BREATH ACTUATED NEBULIZERS

Robert S. Pikarsky1, Russ Acevedo1, Tracey Farrell1, Wendy Fascia1, Renee Bear1, Charles Roman1, William Eklund1



Background: For COPD patients using liquid nebulization, a long acting effect is achieved by using short acting bronchodilators on a scheduled basis. A large number of treatments for in-patient COPD patients are for maintenance bronchodilatation. This pilot protocol evaluated the conversion from Levalbuterol (Lev) to Arformoterol (Arf) for maintenance.

Methods: COPD in-patients assessed to be on maintenance bronchodilators were converted from Lev to Arf. All treatments (tx) were delivered using the Monaghan Medical AeroEclipse Breath Activated Nebulizer (BAN). If the patient could use a mouthpiece device, they received Arf 15 mcg once daily. If a mask was used, they received Arf 15 mcg twice daily. Arf and Lev treatments delivered from 12/23/07 to 5/25/08 were recorded in a database as scheduled, prn breakthrough, or refused treatments. Prn rates are calculated in 100 patient-days to correct for different treatment frequencies. Average tx per day includes scheduled and prn tx. Labor hours were obtained from the AARC Uniform Reporting Manual. RT salary and benefits averaged $31/hr. The device cost per tx was derived from the device cost divided by the change out interval and then divided by number of treatments per day. BAN cost = $4.88, Misty-neb = $0.36. In 2007 38,533 Lev treatments were delivered. We estimate that 60% of treatments can be converted to Arf. The Arf SVN column is for comparison only.

Results: Clinical: Arf 15 mcg BAN Qday: 376 scheduled, 32 prn (8.5 per 100 pt-days), and 8 refusals. 13 of the 32 prn treatments came from 3 patients. Arf 15 mcg mask BID: 185 scheduled, 4 prn (4.3 per 100 pt-days), and 2 refusals. Lev (BAN & mask) TID: 4,281 scheduled, 153 prn (10.7 per 100 pt-days) and 254 refusals. Economic results: See table.

Conclusion: Using Arformoterol Qday with BAN or BID with mask decreased the number of treatments delivered and total cost of delivery with prn treatments that compared favorably with Lev. Better patient selection may decrease the prn rate in the Qday group. The large number of refusals in the Lev group would suggest more patients could be converted to Arf. The BAN, by allowing Qday treatments, was extremely cost effective.