Economic evaluation of nasogastric versus intravenous hydration in infants with bronchiolitis

Area of Science:

• Pediatric critical care
• Health economics
• Respiratory medicine

Background:

• Bronchiolitis is a frequent cause of infant hospitalization, necessitating hydration strategies.
• Current Australian cost data for bronchiolitis interventions are limited, impacting clinical decision-making.
• Non-oral hydration is often required for infants diagnosed with bronchiolitis.

Purpose of the Study:

• To compare the cost-effectiveness of intravenous hydration (IVH) versus nasogastric hydration (NGH) in hospitalized infants with bronchiolitis.
• To provide Australian-specific economic data to guide clinical practice regarding hydration methods.
• To analyze intervention-specific costs as a secondary economic analysis of a randomized trial.

Main Methods:

• A cost-minimization study was conducted using data from a randomized trial of 759 infants.
• Intervention-specific costs for IVH and NGH were collected and compared.
• Analyses were performed on an intention-to-treat basis, considering all treatment-related expenses.

Main Results:

• Nasogastric hydration (NGH) incurred lower intervention costs ($74) compared to intravenous hydration (IVH) ($113), representing a $39 cost difference per child.
• The cost advantage of NGH was consistent across different sites and pricing structures.
• Intervention costs constituted less than 10% of the total costs associated with bronchiolitis admissions.

Conclusions:

• Nasogastric hydration (NGH) is a more cost-effective intervention than intravenous hydration (IVH) for hospitalized infants with bronchiolitis.
• NGH demonstrates a small but significant cost saving, supporting its use in this patient population.
• Further economic evaluations should consider the broader cost implications beyond direct intervention expenses.