The technology of metered-dose inhalers and treatment costs in asthma: A retrospective study of breath actuation versus traditional press-and-breathe inhalers

This paper reviews the impact of the use of technologically dissimilar beta-agonist aerosols—the Maxai TM Autohale TM (pirbuterol acetate) breath-actuated aerosol and the traditional albuterol press-and-breathe inhaler—on the treatment costs of asthma. If, as clinical evidence would suggest, the breath-actuated aerosol is not only as effective as an albuterol inhaler with a spacer, but is easier to use and results in more optimal beta-agonist use by patients, then one might consider the hypothesis that patients possessing a breath-actuated inhaler would, ceteris paribus, experience lower asthma-related treatment costs—principally, those medical costs associated with fewer emergency room visits and hospitalizations. This hypothesis is considered from the perspective of a retrospective claims database study of patients who used one or the other beta-agonist inhaler exclusively. At the descriptive level, costs of treatment for patients using the press-and-breathe inhaler are estimated to be 16.5% greater than costs for patients using the breath-actuated inhaler. In the multivariate analysis, the presence of the breath-actuated inhaler (in a dummy variable analysis) was not only statistically significant ( P < 0.05), but entered with the expected negative sign. Estimated cost impacts under various model specifications are consistent with the magnitude of the cost differences reported in the descriptive analysis. Total cost savings with the Maxai TM Autohale TM ranged from 8.7% to 11.7%, with medical cost savings estimated at 14.6%.