Bowton D L, Goldsmith W M, Haponik E F
Department of Medicine (Pulmonary and Critical Care Medicine), Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC.
Chest. 1992 Feb;101(2):305-8. doi: 10.1378/chest.101.2.305.
Administration of beta-agonist bronchodilators by metered-dose inhaler (MDI) is as effective as administration by hand-held nebulizer (NEB). Recent studies have suggested that MDI therapy is less costly to administer and that routine substitution of MDI for NEB would result in considerable savings to patients and to hospitals. To our knowledge, the actual extent to which MDI therapy would replace NEB therapy or the cost savings realized has not been reported previously. We examined the success and impact on hospital costs of the routine substitution of MDI for NEB therapy in a large tertiary-care hospital. Following introduction of this strategy, more than 60 percent of all aerosol therapy was actually given as MDI. The mean amount of time spent by therapists to provide aerosol therapy was significantly reduced by MDI substitution, falling from 1,576 +/- 131 h/mo, to 992 +/- 116 h/mo (p less than 0.002). The total cost to deliver aerosol therapy fell from $27,600 +/- $2,277/mo to $20,618 +/- $2,086/mo (p = 0.008). Potential cost savings of $83,000 annually were achieved by the hospital, and charges to patients were lowered by approximately $300,000 per year. Routine substitution of MDI therapy for NEB therapy can be accomplished with considerable, but not total, success. This approach results in significant reductions in the cost of health care provision.
使用定量吸入器（MDI）给予β受体激动剂支气管扩张剂与使用手持式雾化器（NEB）给药的效果相同。最近的研究表明，MDI疗法的给药成本更低，常规用MDI替代NEB可给患者和医院节省可观的费用。据我们所知，此前尚未报道MDI疗法实际能在多大程度上取代NEB疗法或实现的成本节省情况。我们在一家大型三级护理医院研究了常规用MDI替代NEB疗法的成功率及其对医院成本的影响。实施该策略后，实际上超过60%的雾化治疗是通过MDI进行的。用MDI替代后，治疗师提供雾化治疗所花费的平均时间显著减少，从每月1576±131小时降至992±116小时（p<0.002）。提供雾化治疗的总成本从每月27600±2277美元降至20618±2086美元（p = 0.008）。医院每年实现了约83000美元的潜在成本节省，患者费用每年降低约300000美元。常规用MDI疗法替代NEB疗法虽不能完全成功，但能取得相当大的成效。这种方法可显著降低医疗保健提供成本。
