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Advantage of inhaled corticosteroids as additional therapy to systemic corticosteroids for pediatric acute asthma
Carlos E Rodriguez-Martinez1,2, Monica P Sossa-Briceño3, Jose A Castro-Rodriguez4
1Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.
Insights
Adding inhaled corticosteroids (ICS) to systemic corticosteroids (SCs) for pediatric asthma exacerbations is more cost-effective. This combination therapy reduces hospital admissions and lowers overall treatment costs compared to standard SCs alone.
Area of Science:
- Pediatric Pulmonology
- Health Economics
- Pharmacoeconomics
Background:
- Systemic corticosteroids (SCs) are effective for acute pediatric asthma exacerbations but have slow onset and high hospital admission rates.
- The cost-effectiveness of adding inhaled corticosteroids (ICS) to SCs remains unclear.
Purpose of the Study:
- To evaluate the cost-effectiveness of ICS plus SCs (ICS+SCs) versus SCs alone for pediatric asthma exacerbations.
- To determine the preferred treatment strategy from a national healthcare system perspective.
Main Methods:
- A decision-analysis model was employed to compare ICS+SCs with SCs.
- Effectiveness data were sourced from a systematic literature review.
- Cost data were derived from hospital bills and national drug price manuals.
Main Results:
- ICS+SCs demonstrated lower average costs per patient (US$88.76) compared to SCs alone (US$97.71).
- The probability of hospital admission was slightly lower with ICS+SCs (0.9000) versus SCs (0.9060).
- The combination therapy (ICS+SCs) showed dominance over standard SCs.
Conclusions:
- ICS+SCs represent a preferred strategy for treating pediatric asthma exacerbations.
- This approach offers a lower probability of hospital admission at reduced total treatment costs.
Abstract:
Objective: Although the efficacy of systemic corticosteroids (SCs) in acute asthma exacerbations is well established, the fact that many children still require admission to hospital and that SCs have a slow onset of action are cause of concern. For this reason, the use of inhaled corticosteroids (ICS) as a therapy added to SCs has been explored, with no clarity about its cost-effectiveness. The aim of the present study was to evaluate the cost-effectiveness of ICS in addition to SCs (ICS + SCs) compared to standard therapy with SCs for treating pediatric asthma exacerbations.Methods: A decision-analysis model was developed to estimate the cost-effectiveness of SCs compared to ICS + SCs for treating pediatric patients with acute asthma exacerbations. Effectiveness parameters were obtained from a systematic review of the literature. Cost data obtained from hospital bills and from the national manual of drug prices. The study was carried out from the perspective of the national healthcare system in Colombia. The main outcome of the model was avoidance of hospital admission.Results: For the base-case analysis, the model showed that compared to SCs, therapy with ICS + SCs was associated with lower total costs (US$88.76 vs.US$97.71 average cost per patient) and a lower probability of hospital admission (0.9060 vs. 0.9000), thus showing dominance.Conclusions: This study shows that compared with standard therapy with SCs, ICS + SCs for treating pediatric patients with acute asthma exacerbations is the preferred strategy because it was associated with a lower probability of hospital admission, at lower total treatment costs.
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