Choose Wisely: Metered Dose Inhalers Versus Nebulized Inhaled Solutions in The Inpatient Setting

Abstract

Background Healthcare expenditures continue to rise, and hospitalization costs remain the driving factor for nationally increasing health expenditures.(1,3) Affordability initiatives targeted at minimizing inpatient drug spending and medication waste are vital. Metered dose-inhalers (MDIs) impose high potential for medication waste as their bulk nature provides a day supply that far exceeds average hospitalization length of stay.(1,7) Kaiser Permanente Baldwin Park Medical Center inpatient pharmacy adopted a cost saving initiative aimed at converting the commonly prescribed ipratropium MDI to its equivalent nebulized solution. Methods This was a retrospective medication use evaluation (MUE), assessing the overall drug cost impact of converting patients from ipratropium MDI to ipratropium nebulized solution. The study period consisted of two phases: the pre-implementation phase from 11/1/2017 to 09/30/2018, and the post-implementation phase from 11/01/2018 to 09/30/2019.The study population consisted of patients admitted to the Critical Care Unit (CCU) and Step-Down Unit (SDU), who were prescribed an ipratropium MDI or ipratropium nebulized solution. Patients who were under the age of 18 years old were excluded. The primary outcome was to analyze the drug cost savings of prescribing nebulized solutions over MDIs in the inpatient setting. The secondary outcome was to assess overall compliance with the conversion protocol. Results Ipratropium MDI administrations declined by 91% (from 3,751 to 336) during the post-implementation phase. An estimated drug cost savings of $68,700 occurred by converting the ipratropium MDIs to ipratropium nebulized solution. Conclusion This conversion protocol was successful at reducing MDI waste and attaining substantial drug cost savings at our medical center over a period of 1 year since implementation.