title: 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.
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.
authors: *Department of Economics.
authors: Paul
authors: P
authors: Spin
authors: †IMPART,College of Pharmacy, Faculty of Health Professions.
authors: Ingrid
authors: I
authors: Sketris
authors: †IMPART,College of Pharmacy, Faculty of Health Professions.
authors: Barbara
authors: B
authors: Hill-Taylor
authors: *Department of Economics.
authors: Courtney
authors: C
authors: Ward
authors: ‡Department of Emergency Medicine,Dalhousie University,Halifax,NS.
authors: Katrina F
authors: KF
authors: Hurley
mesh_terms: D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D036501:Metered Dose Inhalers / Q000191:economics*; D009330:Nebulizers and Vaporizers / Q000191:economics; D009674:Nova Scotia; D010372:Pediatrics; D016012:Poisson Distribution; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000420:Albuterol
keywords: Economic models; health care access; health care evaluation; health care quality; paediatric hospital; salbutamol