The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

CONVERSION FROM INHALED NITRIC OXIDE TO INHALED EPOPROSTENOL REDUCES COSTS OF INHALED PULMONARY VASODILATOR THERAPY IN CRITICALLY ILL PATIENTS.

Susan LaGambina1, Paul F. Nuccio1, Heather Torbic2, Paul Szumita2, Kevin Anger2, Gerald Weinhouse3,1; 1Department of Respiratory Care, Brigham and Women's Hospital, Boston, MA 2Pharmacy Department, Brigham and Women's Hospital, Boston, MA; 3Pulmonary & Critical Care Division, Brigham and Women's Hospital, Boston, MA

Background: The use of inhaled pulmonary vasodilators has become a focus of cost-reduction initiatives in hospitals providing this therapy to critically ill patients. Respiratory Care and Pharmacy Departments are investigating ways to provide this therapy while also reducing costs during the current times of fiscal challenges. Method: Retrospective chart review comparing administrative processes and costs associated with inhaled nitric oxide and inhaled epoprostenol in 105 patients receiving pulmonary vasodilator therapy. Inhaled epoprostenol is ordered via the hospital's provider order entry system, approved in the pharmacy order verification system, and then prepared by the pharmacy department in a viaflex bag which contains 2.4 mg of epoprostenol in 80 mL of sterile diluent specific for epoprostenol (concentration 30 mcg/mL). This preparation is stable for eight hours at room temperature and covered with an amber light protected bag during administration. The initial dose is 0.05 mcg/kg/minute and titrated down to 0.01 mcg/kg/minute depending on patient response and tolerability. The respiratory therapist documents the hanging of a new bag every eight hours by scanning the mixed product in the electronic medication administration record and then administers it through a smart infusion pump via a mechanical ventilator and vibrating mesh nebulizer as a continuous nebulization. Results: A total 105 patients were included in this study with 53 patients receiving inhaled nitric oxide and 52 patients receiving inhaled epoprostenol. Assuming a low contract price for inhaled nitric oxide, the mean cost per patient receiving inhaled nitric oxide was $3,930 ± 4,210 and was $838 ± 997 for patients receiving inhaled epoprostenol (p < 0.0001). Assuming a high contract price for inhaled nitric oxide, the mean cost per patient receiving inhaled nitric oxide was $14,240 ± 15,255 and was $838 ± 997 for patients receiving inhaled epoprostenol (p < 0.0001). Conclusion: Our inhaled epoprostenol program requires a multidisciplinary effort from order entry to administration. Inhaled nitric oxide is 4.5 to 17 times more expensive per patient than inhaled epoprostenol. Sponsored Research - None