OBJECTIVES:

Metered-dose inhalers (MDIs) with spacers are generally preferred to nebulization for the treatment of acute asthma in the emergency department (ED) because they would be less expensive to administer, despite comparable efficacy and their large ecological footprint. Our objective was to compare the cost of these two therapeutic alternatives by applying a time-driven-activity based costing method.

METHODS:

This study took place in an academic ED of Québec city, Canada (80,000 visits/year). Process maps and time estimates were derived by surveying respiratory therapists responsible for administering salbutamol alone or with ipratropium through MDIs or nebulization. The respiratory therapist unit cost (cost per minute), overhead, consumable and medication costs were calculated using financial information from fiscal year 2019-20. The cost of each treatment alternative was estimated by adding the overhead, consumable and medication costs, and the cost of each process obtained by multiplying the respiratory therapist unit cost by the time to complete the process. Because fixed and variable costs differ between MDIs and nebulization, the cumulative cost of several consecutive treatments was compared.

RESULTS: The cost (2020 Canadian values [$]) of the first treatment for acute asthma in the ED is $33.49 and $57.23 for salbutamol and the combination of salbutamol and ipratropium administered by MDIs, and $30.02 and $30.92 for salbutamol and the combination of salbutamol and ipratropium administered by nebulization, respectively. Salbutamol alone by MDI becomes the least expensive alternative by the second treatment. The combination of salbutamol and ipratropium is less expensive by nebulization than by MDIs until the sixth treatment.

CONCLUSIONS:

These cost estimates may encourage care providers to favor the use of nebulization for the treatment of acute asthma in the ED, especially when few treatments of both salbutamol and ipratropium are required.