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A Cost Analysis of Salbutamol Administration by Metered-Dose Inhalers with Spacers versus Nebulization for Patients with Wheeze in the Pediatric Emergency Department: Evidence from Observational Data in Nova Scotia

  • Paul Spin (a1), Ingrid Sketris (a2), Barbara Hill-Taylor (a2), Courtney Ward (a1) and Katrina F. Hurley (a3)...

Abstract

Background

Despite evidence demonstrating the advantages of metered-dose inhalers with spacers (MDI-s), nebulization (NEB) remains the primary method of asthma treatment in some pediatric emergency departments (PEDs). There is a perception that delivering salbutamol by MDI-s is more costly than by NEB. This research evaluates the relative costs of MDI-s and NEB using local, hospital-specific, patient-level data.

Methods

Regression models estimated associations between the salbutamol inhalation method and costs, length of stay (LOS) in the PED and hospital, and the probability of admission. Our population was a random sample of 822 patients presenting with wheeze to the PED in 2008/2009. Control variables included age, sex, triage acuity, time of PED visit, other medications, and vitals. Costs were calculated using the prices and quantities of medical resources used per treatment. Probabilistic sensitivity analysis was used.

Results

Treatment with MDI-s versus NEB was associated with an absolute decrease in hospitalization of 4.4% (p<0.05) and a 25-hour (p<0.001) reduction in average inpatient stay, after controlling for triage acuity and patient characteristics. This resulted in savings of $24/patient in the PED and $180/patient overall (p<0.001). Inpatient care accounted for more than 90% of total patient costs.

Conclusions

Our results suggest economic gains associated with MDI-s for salbutamol inhalation in PEDs. Sensitivity analyses show that this conclusion is not affected by changes in model parameters that may differ by jurisdiction. Since most facilities already collect the data used for this study, our methods could be adopted for a cross-jurisdictional account of the cost effectiveness of MDI-s.

Contexte

Malgré l’existence de données qui démontrent les avantages de l’aérosol-doseur avec tube d’espacement (ADTE), le nébuliseur (NEB) reste le principal moyen de traitement de l’asthme dans certains services des urgences pédiatriques (SUP). L’administration de salbutamol par ADTE, croit-on, coûte plus cher que celle par NEB. La recherche décrite ici visait donc à évaluer le coût de l’utilisation de l’ADTE par rapport à celui de l’utilisation du NEB à l’aide de données locales, propres à un hôpital et relatives aux patients.

Méthode

Des modèles de régression ont permis d’estimer des associations entre les moyens d’administration de salbutamol et les coûts, le séjour au SUP et à l’hôpital ainsi que les probabilités d’hospitalisation. La population à l’étude se composait d’un échantillon aléatoire de 822 patients qui présentaient une respiration sifflante au SUP, en 2008 et en 2009. Les variables de contrôle comprenaient l’âge, le sexe, le degré de gravité au moment du triage, l’heure de consultation au SUP, l’emploi d’autres médicaments et les signes vitaux. Le calcul des coûts tenait compte des prix et de la quantité de ressources médicales employées par traitement. Enfin, les auteurs ont procédé à une analyse de sensibilité probabiliste.

Résultats

Le traitement par ADTE comparativement à celui par NEB a été associé à une diminution absolue de 4,4% (p<0,05) du nombre d’hospitalisations et à une réduction de 25 heures (p<0,001) du séjour moyen à l’hôpital, et ce, après la neutralisation du degré de gravité au moment du triage et des caractéristiques des patients. Dans les faits, ces chiffres se traduisent par une économie de 24 $/patient au SUP et, dans l’ensemble, de 180 $/patient (p<0,001). Les soins aux hospitalisés représentaient plus de 90% des coûts totaux liés au traitement des patients.

Conclusions

Les résultats de l’étude portent à croire qu’il existe des économies associées à l’administration de salbutamol par ADTE, dans les SUP. Les analyses de sensibilité ont démontré que les modifications des paramètres des modèles, susceptibles de varier selon les gouvernements étaient sans incidence sur la conclusion. Comme la plupart des établissements font déjà la collecte de données utilisées dans l’étude en question, il serait possible d’adopter les méthodes décrites ici pour procéder à une mesure pangouvernementale du rapport coût-efficacité de l’utilisation de l’ADTE.

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Copyright

Corresponding author

Correspondence to: Katrina Hurley, Department of Emergency Medicine, Dalhousie University and the IWK Health Centre, Emergency Department, 5850/5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8; Email: kfhurley@dal.ca

References

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