Background: The use of a vibrating mesh nebuliser (VMN) has been associated with a reduction in time in accident and emergency (A&E) and medication consumption compared to the jet nebuliser (JN) in moderate to severe asthmatic patients. However, the economic and environmental benefits of a VMN are currently unknown.

Aims and objectives: To design and build a model to estimate the incremental costs and environmental impact of the VMN when compared to the JN in moderate to severe asthmatic patients receiving aerosol therapy within A&E in the United Kingdom (UK).

Methods: A decision tree framework was developed to determine the proportion of patients discharged or admitted to either an intensive care unit (ICU) or a respiratory medical ward (RMW) following presentation to A&E. Costs were reflective of the National Health Service (NHS) and were obtained from published sources. The resource use inputs were assumption-based and these categories included medication, device-related equipment and hospitalisation costs. Extensive uncertainty analyses were undertaken around all parameters that were assumption based.

Results: Use of a VMN led to a total cost-saving of £130 per patient. Increased nebuliser related costs (£34 per patient) were outweighed by a £164 total savings in A&E, ICU and RMW as well as in staff time and medication costs. The results were most sensitive to the proportion of patients discharged from A&E. The VMN was also associated with 2.01kg fewer CO2 emissions per patient stay than the JN.

Conclusion: For patients with moderate to severe asthma, the use of a VMN rather than JN is estimated to lead to a reduction in both costs and CO2 emissions.