A comparison of the costs of bronchodilator delivery methods in children with asthma exacerbations treated in hospital. The first Polish study in children

Introduction
Recommended methods of administering bronchodilator drugs in children with asthma exacerbations in a hospital include the pressurized metered-dose inhaler (pMDI) and nebulization (NEB). These methods differ in clinical effectiveness, safety and, as some studies indicate, the cost of their use in a child. Aim: To calculate the direct costs of hospital therapy conducted with the use of short-acting β2-agonist (SABA) or its combination with short-acting muscarinic antagonist (SAMA) administered via pMDI with valved holding chamber (VHC) versus the same drugs in NEB in children with asthma exacerbation.

Material and methods
A retrospective analysis of the costs of SABA (salbutamol) and SABA + SAMA (fenoterol + ipratropium bromide) inhalation therapy was performed. Based on the data obtained from the financial department, the pharmacy, and the sterilization department of the university hospital, the direct unit cost of the inhalation therapy in the child was calculated.

Results
The results of the analysis indicate that in a hospital setting the cost of one-time SABA or SABA + SAMA administration via pMDI+VHC is 1.5–2.4 times lower compared to NEB. The payer incurred the lowest costs during anti-obstructive treatment using SABA with pMDI + VHC (PLN 9.39 for one inhalation procedure). The working time of medical staff during the inhalation treatment is the component generating the highest cost for the hospital (up to 40% of direct costs).

Conclusions
In hospital conditions, the supply of SABA or SABA + SAMA with the use of pMDI + VHC in a child with asthma exacerbation is more beneficial financially than the supply of the same drugs in NEB.