Cost-effectiveness of salbutamol via metered-dose inhaler with spacers versus nebulizers in children with asthma exacerbation in middle income country

Background: Previous studies have demonstrated that salbutamol administration via metered-dose inhaler with spacer (MDI-S) is as effective as using a jet nebulizer (NEB) for treating children experiencing asthma exacerbation. However, a paucity of research focuses on the direct medical costs associated with each mode of salbutamol administration for asthma exacerbation. Objective: This study aims to compare the effectiveness and direct medical costs of salbutamol administration via MDI-S versus NEB. Methods: A retrospective cohort study was conducted on the medical records of children under 18 years old presenting with mild to moderate asthma exacerbation. Clinical responses to salbutamol administration were assessed using the Ramathibodi Pediatrics Asthma Scores. The costs and clinical outcomes (i.e., Asthma score and hospitalization averted) were compared using the Incremental Cost-Effectiveness Ratio (ICER) from a hospital perspective. Results: The study included 95 medical records from 72 children, with 33 records of MDI-S and 62 records of NEB. Both the MDI-S and NEB groups showed significant reductions in asthma scores post-treatment. Children with moderate asthma exacerbation treated with MDI-S had a lower hospitalization rate than those treated with NEB (20% vs 57.5%, p = 0.034). The cost-effectiveness analysis indicated that the MDI-S group incurred lower costs and was considered cost-saving compared to the NEB group, with an ICER of-4.60 US dollars per one-point improvement in asthma score and-20.07 US dollars per hospitalization averted. Conclusions: Salbutamol administration via MDI-S offers clinical effectiveness comparable to NEB and is more cost-effective.