Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma

Leversha, Alison; Campanella, Silvana G.; Aickin, Richard; Asher, M. Innes

doi:10.1016/s0022-3476(00)90013-1

Cited by 121 publications

(112 citation statements)

References 35 publications

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“…In addition, two studies examined cost-savings achieved through admission rate changes associated with MDI-s. 4,10 Leversha and colleagues documented significantly decreased costs in patients aged one to four years in a New Zealand PED through reduced hospital admissions in patients using MDI-s. 4 Their savings, NZ$457 (CDN$547) per patient, are more than twice ours. A Canadian study, using non-local clinical data, arrived at estimated savings with MDI-s versus NEB that is remarkably similar to ours (CDN$155 versus $180).…”

Section: Discussionmentioning

confidence: 99%

“…2 MDI-s also result in increased child and parent treatment satisfaction and may reduce staff and caregiver risk during respiratory infection epidemics. [3][4][5] Although PEDs in Canada are now accepting MDI-s as the route of choice for salbutamol inhalation, 6 one of the factors linked to resistance to switching salbutamol inhalation methods is the perception of increased costs. 7,8 The cost-effectiveness of MDI-s versus NEB has been documented, 4,[9][10][11][12] but no published Canadian study has used local clinical and administrative data in their analysis.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] Although PEDs in Canada are now accepting MDI-s as the route of choice for salbutamol inhalation, 6 one of the factors linked to resistance to switching salbutamol inhalation methods is the perception of increased costs. 7,8 The cost-effectiveness of MDI-s versus NEB has been documented, 4,[9][10][11][12] but no published Canadian study has used local clinical and administrative data in their analysis. One Canadian study estimated cost-savings of $155 per PED visit associated with salbutamol delivery via MDI-s. 10 Doan and colleagues used hospital-level data for medication, labour and equipment costs, but drew on a systematic review of randomized controlled trials for patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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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

Spin¹,

Sketris²,

Hill-Taylor³

et al. 2016

CJEM

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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, patientlevel 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Spin¹,

Sketris²,

Hill-Taylor³

et al. 2016

CJEM

View full text Add to dashboard Cite

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“…Thirdly, 64% of UK clinicians used nebulizers for hypoxic children and MDIs for nonhypoxic children, although the overview findings suggest MDI and spacer should be used whenever possible, regardless of severity. In two Canadian surveys of practice (32,33), which also found high rates of use of nebulizers, some barriers to changing practice toward using MDI and spacer were concerns regarding safety (of sterilizing and reusing spacers); concerns regarding increased costs and workload; perceived patient and parental resistance (which appear from three studies to be unfounded) (34)(35)(36); lack of a local clinician who would champion the need for change; and lack of perceived effectiveness of MDI and spacer.…”

Section: Discussionmentioning

confidence: 99%

Inhaled short-acting bronchodilators for managing emergency childhood asthma: an overview of reviews

Pollock

Sinha

Hartling

et al. 2016

Allergy

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International guidelines provide conflicting recommendations on how to use bronchodilators to manage childhood acute wheezing conditions in the emergency department (ED), and there is variation within and among countries in how these conditions are managed. This may be reflective of uncertainty about the evidence. This overview of systematic reviews (SRs) aimed to synthesize, appraise, and present all SR evidence on the efficacy and safety of inhaled short-acting bronchodilators to treat asthma and wheeze exacerbations in children 0-18 years presenting to the ED. Searching, review selection, data extraction and analysis, and quality assessments were conducted using methods recommended by The Cochrane Collaboration. Thirteen SRs containing 56 relevant trials and 5526 patients were included. Results demonstrate the efficacy of short-acting beta-agonist (SABA) delivered by metered-dose inhaler as first-line therapy for younger and older children (hospital admission decreased by 44% in younger children, and ED length of stay decreased by 33 min in older children). Short-acting anticholinergic (SAAC) should be added to SABA for older children in severe cases (hospital admission decreased by 27% and 74% when compared to SABA and SAAC alone, respectively). Continuous nebulization, addition of magnesium sulfate to SABA, and levosalbutamol compared to salbutamol cannot be recommended in routine practice.Acute wheeze in children is one of the most common reasons for presentation to the emergency departments (ED) (1). In school-aged children, acute wheeze usually signifies underlying asthma, while in preschool children this sign may be the result of either asthma or viral-induced wheeze with distinct phenotypes and underlying mechanisms. In these age groups, regardless of the underlying pathology, exacerbations of recurrent wheeze and dyspnoea are largely caused by bronchoconstriction of the small airways. Although most children improve with bronchodilator therapy, many require hospital admission, and others may even require admission to critical or intensive care units. It is important, therefore, that children with wheeze and dyspnoea are treated promptly and appropriately in the ED to reduce symptoms and respiratory distress, mitigate hospital admission, and prevent respiratory failure. Across the UK and many other countries, there is a 10-fold difference in rates of hospital admission for acute asthma in children (2).Although the reasons for this are complex, one factor may be variations among EDs in the management of pediatric asthma, which have recently been described for key interventions such as inhaled bronchodilators (3).The three most common groups of inhaled bronchodilators used to treat acute asthma and wheeze in EDs are short-acting beta-agonists (SABA) such as salbutamol (albuterol), levosalbutamol (levalbuterol), and adrenaline (epinephrine); short-acting anticholinergics (SAACs) such as ipratropium bromide; and, more recently, a third category of muscle relaxants comprising magnesium sulfate (MgSO ...

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“…14, 15 Delgado et al reported a 5% admission rate for the MDI+VHC group versus 20% admissions for the nebulizer group-an incredible 75% reduction.…”

Section: Hospitalization Ratementioning

confidence: 99%

MDI versus Nebulizers for Acute Asthma

Raissy

Kelly

2004

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVE: To evaluate studies comparing metered dose inhalers with holding chambers to nebulizers in the emergency department for the treatment of asthma exacerbation. DATA SOURCE: Primary articles and systematic review provided by the Cochrane Airways Review Group of the Cochrane Library identified by MEDLINE search (1966–February 2004) and through secondary sources. DATA SYNTHESIS: The Cochrane review included 21 randomized clinical trials conducted in hospital emergency departments comparing clinical outcomes following β2 agonist administration via a nebulizer or a metered dose inhaler with holding chamber. Although the relative risk ratio of hospital admission with metered dose inhaler and holding chamber did not differ in children or in adults compared to the nebulizer delivery, none of the individual studies reviewed were powered to detect a difference in the rate of hospital admission. Specific factors in the treatment of acute asthma such as assessment of severity, appropriate outcome selection, appropriate dose selection, and appropriate delivery systems need to be considered to critically evaluate the literature. CONCLUSION: Although available randomized clinical trials suggest equivalency of metered dose inhaler plus holding chambers and nebulized delivery of inhaled β2 agonists, these trials are biased to show no difference in response. There is no data to support the advantage of one method over the other in mild to moderate asthmatic patients either clinically or economically.

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Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma

Cited by 121 publications

References 35 publications

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

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

Inhaled short-acting bronchodilators for managing emergency childhood asthma: an overview of reviews

MDI versus Nebulizers for Acute Asthma

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