Hospital Conversion of Devices for Administration of Long-Acting Antimuscarinic Agent Using Common Canister

Abstract

Background:

Tiotropium HandiHaler poses significant issues for both Respiratory Care and Pharmacy. Despite the HandiHaler being left in the patient's medication drawer, many times it was missing when the respiratory therapist (RT) went to deliver the medication. The RT would then have to retrieve another HandiHaler which comes with an additional 5 capsules. This could, at times, take greater than 15 min between searching for and then retrieving another HandiHaler. This results in disruption in the RT's work flow and the accumulation of extra capsules. The increased frustration on the part of the RT and the pharmacy employee grew over time regarding this issue. Tiotropium is now available in a Respimat device which is being used increasingly in the outpatient setting. There is no institutional size for the Respimat (30 doses). For the above reasons we evaluated Respimat using a Common Canister approach.

Methods:

All patients receiving Tiotropium by HandiHaler from 1/16/18 onwards were converted to Respimat administered by common canister. Pharmacy costs were compared with pre-intervention costs. The cost of the RT's time inefficiencies was estimated.

Results:

Costs: HandiHaler (5 capsules) $37.22, $7.44 per day; Respimat (30 doses) $333.02, $11.10 per day. Pre-intervention monthly HandiHaler cost = $3,481. Average Respimat monthly cost = $11,375. Without common canister the cost for our average LOS of 5.7 days would be for HandiHaler $42.41 and for Respimat $333.02, a 7.85-fold increase. With common canister we had a 3.27 fold cost increase. With 100% common canister delivery, the cost increase would be $11.10/$7.44 = 1.49. 70% of treatments were common canister. With a base salary of $71,500, 15-min interruption to replace a HandiHaler at 60 times a month, the additional RT labor cost = $515. There were no issues with delivering the Respimat by common canister.

Conclusions:

For in-patients, even accounting for the hassle factor and the cost inefficiencies in RT workflow the current pricing for the Respimat is cost prohibitive, even with using Common Canister. An institutional size is expected to be released soon at $39 for 14 doses. At this price the Respimat is cost neutral to the HandiHaler and a significant cost savings with common canister. The inability to get the common canister delivery closer to 100% is due to the number of isolation and flu patients which do not share canisters.

Disclosures:

Acevedo – Sunovion Advisory Board, Monaghan Medical consultant.