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Cost-effectiveness of preferred fluids versus electrolytes in pediatric gastroenteritis
Myla E Moretti1,2, Wendy J Ungar3,4, Stephen B Freedman5
1Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
Apple juice and preferred fluids are more cost-effective than electrolyte solutions for treating pediatric gastroenteritis, leading to fewer treatment failures and significant cost savings for families and healthcare systems.
Area of Science:
- Pediatric Gastroenterology
- Health Economics
- Clinical Pediatrics
Background:
- Electrolyte maintenance solutions are standard for pediatric gastroenteritis but are expensive and less palatable.
- Preferred fluids like apple juice offer a potentially more cost-effective and palatable alternative.
Purpose of the Study:
- To evaluate the incremental cost-effectiveness of using apple juice/preferred fluids versus electrolyte solutions.
- To assess the impact on treatment failures in children with gastroenteritis in an emergency department setting.
- To analyze costs from both societal and healthcare perspectives.
Main Methods:
- A probabilistic cost-effectiveness analysis was conducted using clinical trial and chart data.
- A 14-day time horizon was used, including all direct and indirect costs.
- Cost-effectiveness was determined by comparing treatment failures and costs per patient between groups.
Main Results:
- The apple juice strategy resulted in average per-child savings of CAD $171 (societal) and $147 (healthcare).
- Fewer treatment failures (0.08 fewer per child) were observed with the apple juice strategy.
- Higher costs for electrolyte solutions were linked to increased hospitalizations and parental productivity loss.
Conclusions:
- The apple juice/preferred fluids strategy is dominant over electrolyte solutions for treating mild dehydration from acute gastroenteritis.
- This approach leads to fewer treatment failures and lower societal costs.
- Widespread adoption could yield substantial cost savings and improve clinical outcomes given the prevalence of gastroenteritis.
Background:
While electrolyte maintenance solution is recommended and commonly used in pediatric gastroenteritis, it can be more costly and less palatable than preferred fluids such as apple juice.
Objective:
To assess the incremental cost-effectiveness of apple juice/preferred fluids versus electrolyte maintenance solution in reducing treatment failures in children in an emergency department from societal and health care perspectives.
Methods:
A probabilistic cost-effectiveness analysis was performed using clinical trial and chart data. All intervention, and direct and indirect costs were included, with a 14-day time horizon. Cost-effectiveness was examined by calculating the difference in mean number of treatment failures and mean cost/patient between treatment groups. The probabilistic point estimate and 95% confidence intervals for incremental costs and incremental effectiveness were determined.
Results:
The apple juice strategy was less costly than electrolytes with average per child savings of CAD $171 (95% CI $22 to $1097) from a societal perspective, and $147 (95% CI $23 to $1056) from a health care perspective. There were 0.08 fewer treatment failures per child (95% CI - 0.15 to - 0.02). The higher electrolyte maintenance solution cost was due to more frequent hospitalizations, ongoing care, and greater lost parental productivity due to additional medical visits.
Conclusion:
Apple juice/preferred fluids strategy was dominant over electrolytes in the treatment of children with minimal dehydration secondary to acute gastroenteritis as this option yielded fewer treatment failures and a lower societal cost. Given the high prevalence of acute gastroenteritis, this approach may result in significant cost savings while leading to improved clinical outcomes.
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