The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

COST SAVINGS ASSOCIATED WITH THE IMPLEMENTATION OF ALTERNATIVE INHALED PULMONARY VASODILATOR THERAPY

Christine Wong; Respiratory Therapy, St. Paul’s Hospital, Vancouver, BC, Canada

Background: Since the FDA approval of inhaled nitric oxide in 1995, there have been escalating costs associated with medical grade inhaled nitric oxide administration. With costs rising, less expensive selective pulmonary vasodilators have been sought. Inhaled epoprostenol (flolan), which can be given through continuous nebulization, may be a viable alternative. It is important to note that no selective pulmonary vasodilator therapy has proven to reduce morbidity or mortality. No clinical difference in efficacy of inhaled nitric oxide vs. inhaled epoprostenol has been observed to date. Objective: To decrease overall costs associated with Respiratory Therapist-administered pulmonary vasodilators by 40%, via substituting inhaled epoprostenol for inhaled nitric oxide on approved cases. Method: Policies, protocols, and flow sheets were developed to allow for proper implementation of inhaled epoprostenol. Education of Respiratory Therapists, critical care nurses, and physicians was provided in order to ensure patient safety and promote good team dynamics within the ICU. Under physician approval, patients who presented with acute pulmonary hypertension and/or refractory hypoxemia were given inhaled epoprostenol as opposed to inhaled nitric oxide. Once the order for inhaled epoprostenol was provided, an administration protocol was utilized for the duration of the therapy. Where no order for inhaled epoprostenol was obtained, patients remained on inhaled nitric oxide. Results: When inhaled epoprostenol ($300 Canadian per 24 hours) was substituted for inhaled nitric oxide ($2280 Canadian per 24 hours) during a 16-month period a net savings of $293 040 Canadian was observed, an overall reduction of 40%. Costs per day for inhaled epoprostenol and inhaled nitric oxide therapy were calculated according to both drug and consumables used in a 24-hour period. No additional respiratory therapist hours were used with the implementation of inhaled epoprostenol. Cost savings were determined by calculating actual inhaled epoprostenol used vs. what it would have cost to administer inhaled nitric oxide for the same duration of time. Conclusion: Inhaled epoprostenol significantly reduces overall costs of inhaled pulmonary vasodilator therapy as compared to inhaled nitric oxide. Within our organization, additional savings would be possible if inhaled epoprostenol replaced nitric oxide in all appropriate cases. Sponsored Research - None

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