Cost impact of metered dose inhalers vs small volume nebulizers in hospitalized patients: the Cleveland Clinic experience.

To assess the cost impact of using metered dose inhalers (MDIs) versus small volume nebulizers (SVNs) for hospitalized adult patients not being managed in ICUs, we analyzed the labor, equipment, and medication costs associated with using MDIs at The Cleveland Clinic Foundation. Over the study interval (January 1988-December 1989), a policy was implemented to enhance MDI use, resulting in increased use of MDIs (18% of all bronchodilator treatments in 1989 vs 5% in 1988). Based on a volume of approximately 70,000 bronchodilator treatments/year in our hospital, increased MDI use with this policy reduced direct costs by $26,510, with associated savings in respiratory-therapist time. To extend this analysis of costs to other institutional settings, we present an analysis of projected changes in institutional costs when the volume of bronchodilator therapies and the percentage administered by MDI varies.