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Objective:  The majority of hospitalized patients with asthma or chronic obstructive pulmonary disease (COPD) misuse their inhalers. In a published program, “Nebs no More after 24,” the authors found their program to be effective at reducing unnecessary nebulized treatments, increasing patient education, and decreasing costs. The objective of this study was to develop financial models, both internal to our hospital and more generalizable externally, of the cost impact of transitioning adults hospitalized with asthma or COPD to metered dose inhalers (MDIs) after 24 h of scheduled nebulized medications (“nebs”), when appropriate, to help hospitals make cost-efficient decisions for inhaled medications. Methods:  “Internal” and “external” cost models were developed using number of patients, medication costs, and labor costs for nebulized medications and education for inhalers. Cost-savings were calculated by subtracting costs of nebulized-only cases from costs of nebulizer-plus-MDI cases. Estimates for staffing costs were obtained from the United States Bureau of Labor Statistics. Results:  Cost-savings were estimated at $12,136 or $20,783 in the internal model and $8,927 or $14,283 in the external model when 50% or 80% of patients transitioned from nebs to MDIs, respectively. The marginal cost saving for every additional five new patients (∼1% of  n  = 552) transitioning to MDIs was estimated at $187.50. Models representing transitions from all-nebulized to nebulizer-plus-MDI respiratory medications resulted in cost savings, largely from the reduction of labor cost of nebulizer administration with nebs-only treatment. Therefore, transitioning from nebs to MDIs can lead to cost savings and could allow greater opportunities for inhaler education.

Estimated cost-savings from optimizing use of inhaled medications for inpatients with obstructive lung disease