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Abstract

Introduction: The purpose of this evaluation is to describe the cost savings associated with multimodal interventions aimed at reducing aerosolized bronchodilator use in mechanically ventilated patients without adversely affecting costs associated with length of stay. Methods: Subjects were included in the analysis if they were > 18 years of age; on mechanical ventilation in the ICU; and received aerosolized formulations of albuterol sulfate, ipratropium bromide or albuterol sulfate/ipratropium bromide. Patients were excluded if they had obstructive pulmonary disease as determined by appropriate ICD-9 codes. Results: There were 315 patients who received aerosolized bronchodilator therapy and 168 patients who did not receive aerosolized bronchodilator therapy after implementation of the multi-modal interventions to reduce inappropriate prescribing. Based on wholesale acquisition costs, the total cost of aerosolized bronchodilators dispensed to the adult ICUs over the 6 month post-intervention phase was reduced by $56,960 compared to the 6 month pre-intervention phase ($120,562 vs. $63,602, respectively). The annualized cost savings associated with multi-modal interventions designed to optimize aerosolized bronchodilator use in the adult ICUs is reported to be approximately $113,920. The actual observed lengths of both hospital (20 +/- 0.94 days vs. 11 +/- 1.23 days, p<0.001, respectively) and ICU (11 +/- 0.63 days vs. 5 +/- 0.58 days, p<0.001, respectively) stay were significantly longer in the group of patients that received bronchodilator therapy, but there was no significant change in the lengths of ICU stay (p=0.158) between a historical control comprised of consecutive ICU patients (n=449; 324 bronchodilator, 125 no bronchodilator) and the more recent cohort of patients evaluated after the multi-modal interventions to reduce bronchodilator use had been implemented. Conclusions: Multi-modal efforts to restrict aerosolized bronchodilator therapy in mechanically ventilated patients were successful and led to sustained reductions in use that was associated with substantial reductions in cost.