Use and costs of inhaled nitric oxide and inhaled epoprostenol in adult critically ill patients: A quality improvement project.

PURPOSE: Inhaled epoprostenol and inhaled nitric oxide are pulmonary vasodilators commonly used in the management of acute respiratory distress syndrome and right ventricular failure; however, they have vastly different cost profiles. The purpose of the project was to transition from nitric oxide to epoprostenol as the inhaled pulmonary vasodilator (IPV) of choice in adult critically ill patients and evaluate the effect of the transition on associated usage and costs. METHODS: A single-center, prospective, before and after quality improvement project including adult patients receiving inhaled nitric oxide, inhaled epoprostenol, or both was conducted in 7 adult intensive care units, operating rooms, and postanesthesia care units of a tertiary care academic medical center. The total number of patients, hours of therapy, and costs for each agent were compared between stages of protocol implementation and annually. RESULTS: Seven hundred twenty-nine patients received inhaled nitric oxide, inhaled epoprostenol, or both during the study period. The monthly inhaled nitric oxide use in number of patients, hours, and cost decreased during all stages of the project (p < 0.01). The monthly inhaled epoprostenol use in number of patients, hours, and cost increased during all stages (p < 0.01). Overall, total IPV use increased during the study. However, despite this increase in usage, there was a 47% reduction in total IPV cost. CONCLUSION: Implementation of a staged protocol to introduce and expand inhaled epoprostenol use in adult critically ill patients resulted in decreased use and cost of inhaled nitric oxide. The total cost of all IPV was decreased by 47% despite increased IPV use.

Financial incentive of home continuous positive airway pressure machine use in the inpatient hospital setting.

OBJECTIVES/HYPOTHESIS: Obstructive sleep apnea (OSA) is increasingly recognized as a significant factor in perioperative and inpatient health. Because of this, hospitalized OSA patients are encouraged to utilize continuous positive airway pressure (CPAP) therapy while inpatients. We investigated the cost difference of patient-owned versus hospital-provided CPAP machine use by admitted adult patients with OSA. STUDY DESIGN: Prospective cohort study at a tertiary academic center. METHODS: All new-patient admissions >18 years of age who were prescribed CPAP while inpatients over a 2-month period were included. Demographic information was collected, and cost analysis was performed. RESULTS: CPAP was used for 162 (1.2%) admissions. Mean patient age was 59 ± 13 years; the majority were white (56.8%) and male (64.2%). Average CPAP utilization was 5.3 ± 5.5 nights. The differential cost per day for patients using hospital-provided CPAP was $416.10 more than for patients using home CPAP machines. This cost included direct costs of an extended respiratory therapy (RT) initial visit, machine rental fee ($27.50), and additional RT evaluation time (mean, 85-145 relative value units). The base initial visit was the same for all patients. Over the 2-month study period, the total cost difference in charges was $195,912; this extrapolates to $1,175,471 yearly. CONCLUSIONS: This is the first study to characterize the magnitude of cost savings from utilization of home versus hospital-provided CPAP machines in patients requiring inpatient CPAP machine use. The use of patient-owned CPAP machines may reflect an opportunity to provide cheaper care while maintaining high patient safety and quality care. The actual economic impact to an individual hospital would vary based on the insurance payer mix.