Nebulization therapy: finding the optimum combination of performance, features, and affordability

Finding the Sweet Spot in the Cost-Benefit Matrix

Recently, a claim has been made that the vibrating mesh/membrane nebulizer option has become the first choice for new nebulized pharmaceutical drug developments.  While this may be true for the more expensive medications, the additional cost associated with the electronics and precision manufacturing of these devices is likely to be a significant potential offset for payers for lower cost traditional therapies involving short- and long-acting beta-agonists, muscarinic receptor antagonists, mucolytics and for some antibiotics.

In these cases, the sweet spot could well be a mechanically-operated, breath-enhanced and/or breath-actuated jet nebulizer that delivers a high concentration of suspension- or solution-formulated drug products without risk of atomization orifice plugging, by virtue of air entrainment when the patient inhales, conserves medication when not needed (i.e. during exhalation or if the patient intentionally interrupts therapy by removing their facemask or mouthpiece, for instance to chat to a neighbor), yet has no electronics to add to the overall cost-of-goods.

In the hospital setting, where pressure to minimize costs is high and where most therapies are associated with the treatment of obstructive lung disease, jet nebulizers are simple-to-use and have been the standard of care with unit costs for a continuous nebulizer being close to $1.00. However, such continuous nebulizers waste much of the medication and have high fugitive emissions in comparison with the only slightly more costly breath-actuated jet nebulizers in which droplet generation only takes place during inspiration.  Their residual volumes are relatively high compared with vibrating mesh/membrane nebulizers, but this limitation can be reduced by increasing the fill volume of medication in the reservoir.  Furthermore, with the cost of SABA medication such as albuterol only in the order of ten US dollars per treatment, wastage can be tolerated if there can be confidence that the patient is receiving the appropriate dose of medication.