The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts


Michael McPeck; Respiratory Care, Long Beach Memorial Medical Center, Long Beach, CA

BACKGROUND: To comply with cost reduction goals, I sought to better control costs of providing aerosol drug therapy. Total cost to hospitals for aerosol therapy by RTs includes 3 cost components: supplies, drugs and labor. Supplies may range from <$1 for simple “tee” nebulizers to >$5 for a breath-actuated device. Drug costs range from 10-16 cents (albuterol) to >$70/dose for Tobi. Labor costs vary widely but are easily determined in most hospitals. My goal was to account for many different combinations of supply, drug and labor costs and to graphically present comparison data between two or more scenarios in an intuitive and visually-compelling manner. METHODS: I obtained current hospital cost data from appropriate sources with respect to our average departmental labor cost (including benefits), acquisition cost of different nebulizer systems from our purchasing group and aerosol drug costs from our pharmacy. Using MS Office Excel 2007 I developed a spreadsheet with user input fields for variables to be tested, lookup tables for known constants (cost of different nebulizers, cost of different drugs), and formulas to calculate cumulative cost of treatments over time under differing scenarios. Multiple scenarios reflecting current practice and potential practice changes were devised and input for testing. RESULTS. The spreadsheet rendered a compelling visual comparison of the cumulative cost difference between different treatment scenarios and permitted me to confirm the selection of a conserver-type nebulizer system (Circulaire II) over a breath-actuated system (BAN) on the basis of labor time cost-avoidance. Similarly, I was able to demonstrate that the labor component of aerosol therapy is the greatest component of total cost for many scenarios in which device cost varies widely by as much as 5 or 6-fold. Further, I determined that certain costly drugs (eg, Tobi & Pulmozyme) skew the total cumulative cost so greatly that compensation by labor cost modification is virtually impossible. However, this analysis demonstrated that significant time savings can be identified for other purposes, such as improving patient compliance in patients with multidrug aerosol therapy. CONCLUSION: Graphical spreadsheet analysis enhances cost comparison between different therapy scenarios, enhances our recognition of understanding of the differences, and exposes subtleties that may otherwise go unnoticed, thereby assisting with cost reduction endeavors. Sponsored Research - None