title: Cost-effectiveness of metered-dose inhalers for asthma exacerbations in the pediatric emergency department.
abstract: OBJECTIVE
  To compare the incremental cost and effects (averted admission) of using a metered-dose inhaler (MDI) against wet nebulization to deliver bronchodilators for the treatment of mild to moderately severe asthma in pediatric emergency departments (EDs).
  
  
  METHODS
  We measured the incremental cost-effectiveness from the perspective of the hospital, by creating a model using outcome characteristics from a Cochrane systematic review comparing the efficacy of using MDIs versus nebulizers for the delivery of albuterol to children presenting to the ED with asthma. Cost data were obtained from hospitals and regional authorities. We determined the incremental cost-effectiveness ratio and performed probabilistic sensitivity analyses using Monte Carlo simulations.
  
  
  RESULTS
  Using MDIs in the ED instead of wet nebulization may result in net savings of Can$154.95 per patient. Our model revealed that using MDIs in the ED is a dominant strategy, one that is more effective and less costly than wet nebulization. Probabilistic sensitivity analyses revealed that 98% of the 10 000 iterations resulted in a negative incremental cost-effectiveness ratio. Sensitivity analyses around the costs revealed that MDI would remain a dominant strategy (90% of 10 000 iterations) even if the net cost of delivering bronchodilators by MDI was Can$70 more expensive than that of nebulized bronchodilators.
  
  
  CONCLUSIONS
  Use of MDIs with spacers in place of wet nebulizers to deliver albuterol to treat children with mild-to-moderate asthma exacerbations in the ED could yield significant cost savings for hospitals and, by extension, to both the health care system and families of children with asthma.
authors.affiliation: Division of Pediatric Emergency Medicine, British Columbia Children's Hospital, 4480 Oak St, Vancouver, British Columbia, Canada V6H 3V4. qdoan@cw.bc.ca
authors.forename: Quynh
authors.initials: Q
authors.lastname: Doan
authors.forename: Allan
authors.initials: A
authors.lastname: Shefrin
authors.forename: David
authors.initials: D
authors.lastname: Johnson
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage* / Q000191:economics; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D001955:British Columbia; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000191:economics / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D036501:Metered Dose Inhalers / Q000191:economics*; D009010:Monte Carlo Method; D009330:Nebulizers and Vaporizers / Q000191:economics; D012008:Recurrence; D012720:Severity of Illness Index
chemical_list: D000420:Albuterol