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Cost-effectiveness of epinephrine and dexamethasone in children with bronchiolitis
Amanda Sumner1, Douglas Coyle, Craig Mitton
1Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, and Department of Epidemiology and Community Medicine, University of Ottawa, 401 Smyth Ave, Ottawa, Ontario, Canada K1H 8L1.
Insights
The combination of nebulized epinephrine and oral dexamethasone is the most cost-effective treatment for infant bronchiolitis, offering the best symptom control at the lowest cost. This approach provides superior outcomes for infants experiencing this common respiratory illness.
Area of Science:
- Pediatrics
- Health Economics
- Respiratory Medicine
Background:
- Bronchiolitis is a common respiratory infection in infants, leading to significant healthcare utilization and costs.
- Current treatment options for bronchiolitis vary, with ongoing research into their comparative effectiveness and economic impact.
Purpose of the Study:
- To assess the cost-effectiveness of different bronchiolitis treatments in infants aged 6 weeks to 12 months.
- To compare nebulized epinephrine plus oral dexamethasone against other treatment strategies and no active treatment.
Main Methods:
- Economic evaluation from societal and healthcare system perspectives over 22 days post-enrollment.
- Effectiveness measured by symptom duration (feeding, sleeping, coughing, noisy breathing).
- Nonparametric bootstrapping used to assess uncertainty in cost and effectiveness estimates.
Main Results:
- The combination of nebulized epinephrine and oral dexamethasone was the dominant strategy, being both most effective and least costly.
- Average societal costs were lowest for combination therapy ($1115) compared to no treatment ($1210), epinephrine alone ($1322), and dexamethasone alone ($1360).
- The combination therapy also resulted in the shortest average time to symptom curtailment (12.1 days).
Conclusions:
- Combination therapy with nebulized epinephrine and oral dexamethasone is the most cost-effective treatment for infant bronchiolitis.
- This approach offers the best balance of symptom control and economic efficiency for managing bronchiolitis in infants.
Objective:
Using data from the Canadian Bronchiolitis Epinephrine Steroid Trial we assessed the cost-effectiveness of treatments with epinephrine and dexamethasone for infants between 6 weeks and 12 months of age with bronchiolitis.
Methods:
An economic evaluation was conducted from both the societal and health care system perspectives including all costs during 22 days after enrollment. The effectiveness of therapy was measured by the duration of symptoms of feeding problems, sleeping problems, coughing, and noisy breathing. Comparators were nebulized epinephrine plus oral dexamethasone, nebulized epinephrine alone, oral dexamethasone alone, and no active treatment. Uncertainty around estimates was assessed through nonparametric bootstrapping.
Results:
The combination of nebulized epinephrine plus oral dexamethasone was dominant over the other 3 comparators in that it was both the most effective and least costly. Average societal costs were $1115 (95% credible interval [CI]: 919-1325) for the combination therapy, $1210 (95% CI: 1004-1441) for no active treatment, $1322 (95% CI: 1093-1571) for epinephrine alone, and $1360 (95% CI: 1124-1624) for dexamethasone alone. The average time to curtailment of all symptoms was 12.1 days (95% CI: 11-13) for the combination therapy, 12.7 days (95% CI: 12-13) for no active treatment, 13.0 days (95% CI: 12-14) for epinephrine alone, and 12.6 days (95% CI: 12-13) for dexamethasone alone.
Conclusion:
Treating infants with bronchiolitis with a combination of nebulized epinephrine plus oral dexamethasone is the most cost-effective treatment option, because it is the most effective in controlling symptoms and is associated with the least costs.
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