Nebulization will continue to play a major role as a medical aerosol delivery route, and there will be a place for both simple and more complex devices in the armamentarium of treatment options for clinicians to consider. The challenge facing both developers and prescribers when choosing the most appropriate nebulizer to use is not simple and is influenced by the relative importance of the required delivery attributes. In some instances, there may be a requirement, and therefore potential justification, for a high cost delivery system. However, in many other situations, a perfectly reasonable solution may be found at a much lower cost.
What are the component costs of a nebulizing system?
Nebulizers as a class of OIP have undergone much development during the past 30 years or so, with an increase in features, most of which are intended to improve targeting of medication to specific regions of the lungs, thereby increasing drug delivery efficacy. These improvements have a price tag associated with them because the overall cost envelope for a nebulizer-based delivery system is made up of three main components (Figure 1):
- the basic device itself, including the patient interface (mouthpiece, facemask, nasal prongs), and its gas supply (compressed air or portable compressor);
- the medication delivered that may contain more than one active pharmaceutical ingredient (API);
- additional features, in particular, electronic aids that are able both to record and control the timing of medication delivery, and in at least one instance (Vectura’s Akita Jet), the patient’s inhalation maneuver.
It is in the addition of supporting smart features that many of the recent advances in nebulizer technology have taken place. Nevertheless, it may come as a surprise to realize that the low technology continuous jet nebulizer is still in widespread use, especially in the hospital environment, where cost is a significant driver for payers to maintain the status quo, despite evidence that there are more efficient options for medication delivery. This situation is also linked to the widespread and relatively low cost of short-acting bronchodilators (SABAs), such as albuterol (salbutamol), that are commonly the first line rapid therapy to alleviate reversible bronchoconstriction, especially in association with asthma, and also with some allergic reactions.
