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Treatment, outcomes and costs of asthma exacerbations in Chilean children: a prospective multicenter observational
A M Herrera1, P Brand2, G Cavada3
1Santa María Clinic, Santa María 500, Santiago, Zip Code 7520378 Región Metropolitana, Chile; School of Medicine, Los Andes University, Monseñor Alvaro del Portillo 12455, Santiago, Zip Code 7620001 Región Metropolitana, Chile.
Insights
Severe asthma exacerbations in Chilean children show significant regional therapy variations and high costs. Many children experience poor outcomes post-discharge, underscoring a need for standardized treatment protocols.
Area of Science:
- Pediatric pulmonology
- Health services research
- Clinical epidemiology
Background:
- Severe asthma exacerbations in children represent a significant healthcare burden.
- Understanding regional variations in treatment is crucial for optimizing care and resource allocation.
Purpose of the Study:
- To investigate geographical disparities in severe pediatric asthma exacerbation management within Chile.
- To estimate the economic impact of these treatment variations.
Main Methods:
- An observational prospective cohort study was conducted across 14 Chilean hospitals over one year.
- Data on oxygen use, pharmacological treatments, and hospitalization costs were collected.
- Six-month post-discharge follow-up assessed emergency room visits, systemic corticosteroid use, and controller treatment adherence.
Main Results:
- Significant variations in oxygen, systemic corticosteroid, and antibiotic use were observed between regions and hospitals.
- Heterogeneity in the use of specific medications like aminophylline, magnesium sulfate, and ketamine was noted.
- The average hospitalization cost was $1910 USD, with a substantial proportion of patients experiencing poor outcomes post-discharge.
Conclusions:
- Considerable practice variation exists in managing severe pediatric asthma exacerbations in Chile.
- These variations are linked to poor patient outcomes and significant healthcare expenditures.
- Standardization of treatment protocols may improve outcomes and reduce costs.
Objective:
To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures.
Methods:
Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated.
Results:
396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations.
Conclusions:
Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.
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