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ECONOMIC IMPACT RESULTING FROM A CONVERSION TO LEVALBUTEROL EVERY SIX TO EIGHT HOURS

Crouse Hospital, Syracuse, NY

PURPOSE: Crouse Hospital approved an automatic conversion from Racemic Albuterol (Alb) 2.5mg Q4h to either Levalbuterol (Lev) 0.63 mg Q6h or Lev 1.25 mg Q8h. To further maximize Respiratory Therapist time we took the next step of automatic conversion of all Lev Q6h to Lev Q8h.

METHODS: All protocol treatments delivered between 10/04 and 4/05 were recorded. Pre-conversion estimates for Alb Q4h were twice the current Lev Q8h protocol. The ratio of Lev Q6h to Q8h delivered between 1/04 and 4/04 (prior protocol) was 85%:15%. The cost for unit dose Alb was $0.22. The cost for unit dose Lev was $1.85. We used the 0.26 hour per treatment time as reported in the AARC Uniform Reporting Manual. The FTE average cost (salary/benefits) = $23.80/hr. All aerosol therapy was provided with the use of the AeroEclipse Breath Actuated Nebulizer (BAN).

RESULTS: The table shows the drug and labor cost for the current protocol and the estimated number of treatments, with their respective costs, for the prior protocol and pre-conversion periods. For the current protocol, the drug cost of $16,482 is lower than the prior protocol and considerably higher than the pre-conversion period. Labor costs decreased with each protocol as the number of treatments dropped. The drop in labor cost more than offset the increase drug costs in each protocol. The largest savings was seen with the current Lev Q8h protocol. The Respiratory Care Department’s total expenses for the first 3 months of this year was 8.6% under budget and 7.9% below the same time period in 2004.

CONCLUSION: Hospital-wide conversion to Lev is cost-effective when administered on both a Q6h and Q8h frequency with the maximum benefit at the Q8h frequency. Therapist availability was enhanced with fewer scheduled treatments.

CLINICAL IMPLICATIONS: The conversion to Lev allows the ability to meet our patient care demands and for the reallocation of workforce needs in an economically advantageous manner.

Pre-conversion Prior Protocol Current Protocol Treatments Alb Q4h 17,818 Treatments Lev Q6h 9,642 Treatments Lev Q8h 1,678 8,909 Total treatments 17,818 11,320 8,909 Drug cost (dollars) $3,920 $20,942 $16,482 Labor (hours) 4,633 2,943 2,316 Labor cost (dollars) $110,258 $70,048 $55,129 Total cost (dollars) $114,178 $90,990 $71,611 Savings compared with current protocol $42,567 $19,380

DISCLOSURE: Robert Pikarsky, None.