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A cost-effectiveness analysis of dexamethasone versus prednisone in pediatric acute asthma exacerbations
Annie Lintzenich Andrews1, Kelli A Wong, Daniel Heine
1Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA. andrewsan@musc.edu
Insights
Shorter dexamethasone courses significantly reduce pediatric asthma emergency department (ED) revisits and hospitalizations compared to prednisone. This strategy also offers substantial cost savings for healthcare systems.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacoeconomics
- Respiratory Medicine
Background:
- Asthma exacerbations are a common reason for pediatric emergency department (ED) visits.
- Corticosteroids, such as prednisone and dexamethasone, are standard treatments for pediatric asthma exacerbations.
- The optimal corticosteroid regimen balancing efficacy and cost-effectiveness remains an area of investigation.
Purpose of the Study:
- To conduct a cost-effectiveness analysis comparing dexamethasone versus prednisone for pediatric asthma exacerbations in the ED.
- To evaluate the impact of different dexamethasone dispensing strategies (prescription vs. dispensed) on outcomes and costs.
Main Methods:
- A decision analysis model was employed to compare treatment arms: 5-day prednisone vs. 2-day dexamethasone (prescription or dispensed).
- Data from published studies on prescription filling, compliance, and steroid efficacy were utilized.
- Projected rates of ED relapse visits, hospitalizations, direct costs, and indirect costs were compared.
Main Results:
- The 2-day dexamethasone regimen, particularly when dispensed at the ED, showed lower rates of return ED visits (8 per 100 patients) and hospitalizations (1.9 per 100 patients) compared to 5-day prednisone (12 and 2.8 per 100, respectively).
- Total costs per 100 patients were significantly lower for dexamethasone ($15,000 for dispensed vs. $18,500 for prescription) compared to prednisone ($22,000).
- Cost savings of $3,500 to $7,000 per 100 patients were observed with dexamethasone compared to prednisone.
Conclusions:
- A 2-day course of dexamethasone is a more cost-effective strategy than a 5-day course of prednisone for treating pediatric asthma exacerbations in the ED.
- This shorter dexamethasone regimen reduces subsequent ED visits and hospital admissions within 7-10 days.
- Implementing dexamethasone, especially with on-site dispensing, offers significant cost savings and improved resource utilization.
Objectives:
The objective was to evaluate the cost-effectiveness of dexamethasone versus prednisone for the treatment of pediatric asthma exacerbations in the emergency department (ED).
Methods:
This was a cost-effectiveness analysis using a decision analysis model to compare two oral steroid options for pediatric asthma patients: 5 days of oral prednisone and 2 days of oral dexamethasone (with two dispensing possibilities: either a prescription for the second dose or the second dose dispensed at the time of ED discharge). Using estimates from published studies for rates of prescription filling, compliance, and steroid efficacy, the projected rates of ED relapse visits, hospitalizations within 7 to 10 days of the sentinel ED visit, direct costs, and indirect costs between the two arms were compared.
Results:
The rate of return to the ED per 100 patients within 7 to 10 days of the sentinel ED visit for the prednisone arm was 12, for the dexamethasone/prescription arm was 10, and for the dexamethasone/dispense arm was 8. Rates of hospitalization per 100 patients were 2.8, 2.4, and 1.9, respectively. Direct costs per 100 patients for each arm were $20,500, $17,200, and $13,900, respectively. Including indirect costs related to missed parental work, total costs per 100 patients were $22,000, $18,500, and $15,000, respectively. Total cost savings per 100 patients for the dexamethasone/prescription arm compared to the prednisone arm was $3,500 and for the dexamethasone/dispense arm compared to the prednisone arm was $7,000.
Conclusions:
This decision analysis model illustrates that use of 2 days of dexamethasone instead of 5 days of prednisone at the time of ED visit for asthma leads to a decreased number of ED visits and hospital admissions within 7 to 10 days of the sentinel ED visit and provides cost savings.
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