PURPOSE OF THE STUDY.
To compare the incremental cost and effects (eg, averted admission to hospital) of using a metered-dose inhaler (MDI) against wet nebulization to deliver bronchodilators for the treatment of mildly to moderately severe asthma in pediatric emergency departments (EDs).
The population was obtained from a Cochrane systematic review in which the efficacy of using MDIs versus nebulizers for the delivery of albuterol to children who presented to the ED with asthma were compared.
Cost data were obtained from hospitals and regional authorities involved in the Cochrane review studies. The incremental cost-effectiveness ratio was determined, and Monte Carlo simulations were used to perform probabilistic sensitivity analyses.
Using MDIs in the ED versus wet nebulization might result in a net savings of $154.95 (Canadian dollars [CAN$]) per patient. Models suggest that using MDIs is both more effective and less costly than wet nebulization. Sensitivity analyses revealed that MDIs would remain the better strategy even if the net cost of using an MDI was CAN$70 more expensive than using nebulized bronchodilators.
Using MDIs with spacers instead of wet nebulizers to deliver albuterol to treat children with mild-to-moderate asthma exacerbations in the ED could lead to significant cost savings.
Although not statistically significant (P = .062), the MDI protocol was more likely to prevent hospital admission than using nebulized bronchodilators. Each hospitalization averted would save CAN$2499. At the same time, using albuterol MDI (CAN$262.73) versus albuterol via nebulizer (CAN$417.68) for acute asthma in the ED would also be less expensive (net cost savings: CAN$154.95). The authors noted that these results are only generalizable to single-payer health care models similar to those assessed in Canada.
- Copyright © 2011 by the American Academy of Pediatrics