The Science Journal of the American Association for Respiratory Care

Conference Proceedings

November 2002 / Volume 47 / Number 11 / Page 1321

Economic Aspects of Introducing New Nebulizer Technology

Patrick J Dunne MEd RRT FAARC

Introduction
What Are the Issues?
      1. Era of Limited Resources
      2. Expense of New Technology
      3. Getting New Technology Accepted
      4. Providing Cost/Benefit Analysis
      5. Impact of Activated Consumers
Pharmacoeconomics: Just for New Drugs?
Types of Economic Analysis
      Cost Minimization Analysis
      Cost-Effectiveness Analysis
      Cost/Benefit Analysis
      Cost/Utility Analysis-
Types of Pharmacoeconomic Studies
      Prospective Economic Trial
      Piggyback Trial
      Review of an Existing Database
      Modeling
Obstacles to New Nebulizer Technology
Justifying Value: Some Caveats
Summary
The adoption of new medical technology has been a major factor in the development of today's highly sophisticated health care delivery system. Recently, important breakthroughs in biotechnology have introduced the possibility that certain terminal diseases may soon become a thing of the past. However, these advances have come at a steep price. Total health care spending in the United States is at an all-time high and the rate of increase in annual expenditures is once again in the double-digit neighborhood. It is clear that it will no longer be "business as usual" in health care, especially with regard to the introduction of new technology. New economic realities now require that those advocating the adoption of a new drug, device, or treatment balance their clinical enthusiasm with cost-effectiveness considerations. This is especially important when the cost of a new drug or device is higher than that of existing drugs or devices. Unlike former times, when the decision to adopt new medical technology resided primarily with clinicians, the approval process is now exceedingly more complex and involves many more individuals, some of whom, clinicians and non-clinicians alike, tend to focus more on protecting their budgets than on approving expenditures for new technology. Pharmacoeconomics has emerged to formalize the decision-making process for the adoption of new drugs. Since many of the issues are similar, the basic principles of pharmacoeconomics hold promise for physicians and therapists championing the adoption of new nebulizers. Pharmacoeconomic data, when gathered, reviewed, and presented in a standardized and unbiased manner, can be a valuable tool to help justify the overall cost/benefit advantages of new nebulizer technology.
Key words: nebulization, nebulizer, aerosol, cost-effectiveness, cost/benefit, cost/utility, pharmacoeconomics, economics.
[Respir Care 2002;47(11):1321–1331]

Introduction

The decision to adopt and implement new technology into a health care setting has never been more formidable. In today's environment, health care financial resources are limited, yet demographic, epidemiological, and societal changes are steadily increasing the demand for health care services. The percentage of the total population entering "senior citizen" status is increasing and the elderly are now living longer than ever before. Both of these trends will substantially impact the United States health care delivery system over the next several decades.

Further fueling the increasing demand for health care services is a relatively recent trend to focus on certain chronic medical conditions and the huge financial impact of delivering suboptimal care to that patient population. New care paradigms are emerging that attempt to make individuals afflicted with chronic medical conditions less dependent on acute care, through the active promotion of preventive self care, itself a relatively recent addition to the health care landscape.

Accordingly, the demand for health care services nationwide is not expected to abate any time soon. Nor is it likely that a massive infusion of new funding will be forthcoming. Health care providers repeatedly hear that the industry is now expected to "do more with less."

With so many factions competing for limited health care financial resources, clinicians wishing to introduce a new technology or drug face an uphill battle. This is especially true when the technology or drug being targeted for replacement has a long history of perceived successful use and an acquisition cost that, over time, has come to be perceived as relatively inexpensive. When attempting to replace the status quo, proponents will need to overcome initial misgivings by demonstrating superior clinical and financial outcomes with the new drug or device.

The new nebulizer technologies discussed during the conference on Liquid Nebulization: Emerging Technologies (proceedings published in this and the following issue of RESPIRATORY CARE Journal) are a radical departure from the status quo. They are more efficient, more clinically effective, and will substantially broaden the boundaries of aerosol therapy, to include applications to nonpulmonary systemic conditions (eg, aerosolized insulin for Type I insulin-dependent diabetics). This review examines the obstacles and often conflicting issues that must be considered when introducing new, more effective, yet more costly nebulizers. Since there is a lack of relevant data addressing the specific challenge of introducing new nebulizers, I explore the potential advantages of using pharmacoeconomics (long used to justify the adoption of new drugs) to support the introduction of new nebulizers.

The entire text of this article is available in the printed version of the November 2002 RESPIRATORY CARE.

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