A Whole Hospital Conversion From Tiotropium Handihaler to Institutional Size Tiotropium Respimat Using Common Canister

Abstract

Background: Tiotropium HandiHaler posed significant issues to respiratory care and pharmacy even with our common canister approach. We looked for alternatives to improve respiratory therapist (RT) workflow and to manage cost. We piloted the non-institutional size tiotropium Respimat due to the increase use in the outpatient settings. At the time of the initial trial Respimat was not available in an institutional size. Our findings showed that the non-institutional size was cost prohibitive, however improved RT workflow. In July of 2018 the institutional size was made available. For the above reasons we evaluated the institutional size Respimat using common canister. Methods: All patients receiving tiotropium by Handihaler from 1/18 onwards were converted to the non-institutional size Respimat and administered by common canister. On 7/18 Respimat was converted to the institutional size and administered by common canister. We compared the actual pharmacy costs of non-institutional and institutional size Respimat, both administered with common canister. Costs with 100% or no common canister delivery were estimated. Results: Costs: HandiHaler (5 capsules) $37.22, $7.44 per day; non-institutional size Respimat (30 doses) $333.02, $11.10 per day; institutional size Respimat (14 doses) $36.29, $2.59 per day. Pre-intervention monthly HandiHaler cost was $3,481. Average non-institutional size Respimat monthly cost using common canister was $11,375, a 3.27 fold increase in cost. Common canister was used 72% of the administrations. Average Institutional size Respimat monthly cost using common canister was $1,641, a 53% reduction in HandiHaler cost. Common canister was used 76% of the administrations. Treatments on influenza and isolation patients were done without common canister. Estimated average monthly cost of institutional size Respimat without common canister would be $1,212, a 14% reduction in HandiHaler cost. Conclusions: Tiotropium delivered by institutional size Respimat is cost effective compared with HandiHaler. Significant additional cost savings can be achieved with common canister. Delivery with the HandiHaler can be eliminated. Disclosures: Acevedo - consultant for Monaghan Medical and Sunovion.