Financial effect of converting ipratropium–albuterol therapy from inhalers to nebulizer treatments at an academic health system

PURPOSE.The results of a study to assess the financial impact of an automatic formulary substitution of ipratropium–albuterol nebulization solution for ipratropium–albuterol metered-dose inhalers (MDIs) at an academic health system are reported. METHODS.The study was conducted at a 1242-bed urban academic health system. Data were collected regarding all respiratory medication administrations during a three-month period before the MDI-to-nebulizer substitution (October–December 2012) and the same period of 2013 (after the substitution was implemented). Purchasing data were compared between the two time periods to measure the impact of the formulary substitution on pharmacy department costs, and documented administrations were assessed to evaluate associated changes in respiratory therapist (RT) workload. RESULTS.With 100% prescriber compliance with the formulary substitution, the number of MDI administrations of ipratropium–albuterol declined from 13,667 in October–December 2012 to zero in the same period of 2013. The substitution required expenditures for equipment (vibrating mesh nebulizer technology and patient-specific kits) and RT personnel (one additional RT was hired), but those added costs were substantially outweighed by cost savings resulting from a substantial reduction in overall respiratory drug spending. CONCLUSION.An automatic substitution of ipratropium–albuterol nebulization solution for MDIs resulted in a three-month savings of $99,359 in drug cost and an extrapolated full-year savings of $397,436. When additional costs associated with the substitution were taken into account, there was an overall savings of $146,806 during the implementation year and a projected savings of $257,936 for each following year.