To quantify the hospital economic impact comparing racemic albuterol (ALB) versus levalbuterol (LEV) in the emergency department (ED) treatment of patients presenting with acute asthma.
ED patients with acute asthma were retrospectively reviewed over a 9 month consecutive period. Outcome measures included ED admission rate, length of stay (LOS), arrival acuity, payer status, and treatment costs. Patients were excluded for age less than 1 year or if no treatment for acute asthma was rendered.
A total of 736 consecutive cases were reviewed, including 608 patients treated with ALB and 128 patients treated with LEV. The indigency rate was approximately 25%. There were 92 (15.1%) admitted patients treated with ALB and 6 (4.7%) admitted patients treated with LEV(p=0.0016; Chi-square). The number-needed-to-treat (NNT) to achieve ED discharge benefit was 9.58 patients. No significant differences in age, gender, LOS in ED, or arrival acuity were noted between the groups (p=NS; ANOVA). The drug costs were $0.25 and $1.50 per dose for ALB and LEV respectively. The average ED charge for discharged patients receiving ALB was $422.30 ± 230.61 and $404.56 ± 192.56 for those patients receiving LEV. The average LOS for admitted patients was 3.8 days. The per diem rate for admitted patients was $945 and the per diem cost of care was $780. Based on these data, a financial risk:benefit ratio of approximately 1:80 favoring LEV was determined for ED treatment. The hospital revenue loss for admitted patients was $40,600 for RAC and $13,500 for LEV.
Patients treated with LEV had a better pharmacoeconomic outcome and ED discharge rate. The hospital sustained less of a financial loss for admitted patients using levalbuterol. This study may indicate beneficial economic and clinical effects of levalbuterol in patients with acute asthma.
Levalbuterol use is controversial due to its perceived negative financial impact. This study demonstrates in large retrospective series that there are both financial and clinical benefits to using levalbuterol in patients presenting to the ED with acute asthma.
David Schreck, None.