Cost and Time Implications Driven by Albuterol Shortage in a Pediatric Hospital

Abstract

Background:

Albuterol is a common drug utilized to treat bronchospasm secondary to asthma exacerbation. Asthma is one of the leading causes of pediatric hospitalization in the United States. A national shortage of albuterol affected pediatric hospitals beginning in 2022. The drug shortage required numerous countermeasures to manage inventory and ensure available supply to ill pediatric patients. We aim to review the impact of albuterol shortage countermeasures in our standalone children’s hospital (244 beds, Level 1 Trauma Center/ Level IV NICU) relative to cost and department operations.

Methods:

A multi-disciplinary team of respiratory therapists (RTs), pharmacists (pharm), and physicians (MDs) began meeting in September 2022 to plan and approve countermeasures to conserve and manage inventory of albuterol. Each countermeasure (Figure 1), while necessary to ensure drug availability to patients, affected the RT and Pharm teams immensely. An IRB approved review of cost and impact to manage the albuterol countermeasures was addressed by the multi-disciplinary team post intervention.

Results:

Total number of albuterol doses delivered from 9/1/2022-4/30/2023 was 46,742. Albuterol MDI use increased from 40% to 56%. Nebulized albuterol decreased from 52% to 40% during the study period. Figure 2 details the estimated cost impact per countermeasure for RTs and Certified Pharmacy Technicians (CPhT). Repackaging of nebulized albuterol decreased the shelf life, constrained operations and increased waste as usage vacillated. RTs and pharm invested time in coaching providers on proper product selection based on availability and patient condition.

Conclusions:

National shortages of albuterol affected cost and labor resources to support adequate inventory to treat pediatric patients with reversible bronchospasm. An interdisciplinary team was imperative to managing the supply change challenges of a complex patient population. While cost considerations are a primary source of data in management of supply chain challenges, the added operational and staff challenges were the most difficult to manage. Further research must be done to guide supply chain challenge management.

Figure 1 shows the timeline of management events put in place as countermeasures in response to liquid Albuterol shortages.

Figure 2 displays the cost analysis for all countermeasures related to Albuterol shortage management.