Related Experiment Video
Updated: Apr 21, 2026
Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
Published on: November 4, 2010
Economic evaluation of nebulized magnesium sulphate in acute severe asthma in children
Stavros Petrou1, Angela Boland2, Kamran Khan3
1Warwick Clinical Trials Unit,Division of Health Sciences,University of Warwicks.petrou@warwick.ac.uk.
Insights
Nebulized magnesium sulphate (MgSO4) shows a high probability of being cost-effective for acute pediatric asthma, particularly in reducing asthma severity scores. However, its cost-effectiveness for improving quality-adjusted life-years (QALYs) is less certain.
Area of Science:
- Pharmacoeconomics
- Pediatric Emergency Medicine
- Respiratory Medicine
Background:
- Acute asthma is a common pediatric emergency requiring effective and cost-efficient treatments.
- Nebulized magnesium sulphate (MgSO4) is explored as an adjuvant therapy for severe acute asthma in children.
- Evaluating the cost-effectiveness of MgSO4 is crucial for UK National Health Service (NHS) resource allocation.
Purpose of the Study:
- To estimate the cost-effectiveness of nebulized magnesium sulphate (MgSO4) for acute pediatric asthma.
- To assess MgSO4's value from the perspective of the UK National Health Service and personal social services.
- To determine cost-utility outcomes based on quality-adjusted life-years (QALYs).
Main Methods:
- Economic evaluation based on a multi-center randomized placebo-controlled trial involving 508 children (aged 2-16) with severe acute asthma.
- Children received nebulized salbutamol and ipratropium bromide with either MgSO4 or saline.
- Cost-effectiveness analyzed using the Yung Asthma Severity Score (ASS) and QALYs, with nonparametric bootstrap methods for acceptability curves.
Main Results:
- MgSO4 demonstrated a 75.1% probability of cost-effectiveness at a £1,000/unit ASS reduction threshold and was more effective in 88.0% of cases.
- At a £20,000/QALY gained threshold, MgSO4 had a 67.6% probability of being cost-effective, but only an 8.5% probability of being more effective in generating QALYs.
- Sensitivity analyses indicated that QALY estimation methods significantly influenced the economic evaluation outcomes.
Conclusions:
- The probability of nebulized isotonic MgSO4 being cost-effective as an adjuvant for severe acute pediatric asthma is below 70% for accepted quality-adjusted life-year (QALY) thresholds.
- While MgSO4 shows promise in reducing asthma severity scores, its broader cost-utility impact requires careful consideration of QALY estimation.
Objectives:
The aim of this study was to estimate the cost-effectiveness of nebulized magnesium sulphate (MgSO4) in acute asthma in children from the perspective of the UK National Health Service and personal social services.
Methods:
An economic evaluation was conducted based on evidence from a randomized placebo controlled multi-center trial of nebulized MgSO4 in severe acute asthma in children. Participants comprised 508 children aged 2-16 years presenting to an emergency department or a children's assessment unit with severe acute asthma across thirty hospitals in the United Kingdom. Children were randomly allocated to receive nebulized salbutamol and ipratropium bromide mixed with either 2.5 ml of isotonic MgSO4 or 2.5 ml of isotonic saline on three occasions at 20-min intervals. Cost-effectiveness outcomes were constructed around the Yung Asthma Severity Score (ASS) after 60 min of treatment; whilst cost-utility outcomes were constructed around the quality-adjusted life-year (QALY) metric. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves at alternative cost-effectiveness thresholds for either: (i) a unit reduction in ASS; or (ii) an additional QALY.
Results:
MgSO4 had a 75.1 percent probability of being cost-effective at a GBP 1,000 (EUR 1,148) per unit decrement in ASS threshold, an 88.0 percent probability of being more effective (in terms of reducing the ASS) and a 36.6 percent probability of being less costly. MgSO4 also had a 67.6 percent probability of being cost-effective at a GBP 20,000 (EUR 22,957) per QALY gained threshold, an 8.5 percent probability of being more effective (in terms of generating increased QALYs) and a 69.1 percent probability of being less costly. Sensitivity analyses showed that the results of the economic evaluation were particularly sensitive to the methods used for QALY estimation.
Conclusions:
The probability of cost-effectiveness of nebulized isotonic MgSO4, given as an adjuvant to standard treatment of severe acute asthma in children, is less than 70 percent across accepted cost-effectiveness thresholds for an additional QALY.
Related Concept Videos
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...
01:18Drug Delivery: Enteral Route
01:25Antiasthma Drugs: β2-Adrenoceptor Agonists
One class of bronchodilators includes β2-adrenoceptor agonists. These agents target the β2-adrenoceptors located on bronchial smooth muscle cells. By stimulating these receptors, β2-agonists induce...
01:24Antiasthma Drugs: Methylxanthines
Theophylline is thought to inhibit phosphodiesterase enzymes, increasing intracellular levels of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP). This rise in cAMP and cGMP concentrations stimulates cardiac function,...
01:30Adrenergic Agonists: Therapeutic Uses
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and...