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Published on: February 27, 2018
Cost-effectiveness of Prednisolone to Treat Bell Palsy in Children: An Economic Evaluation Alongside a Randomized
Xiuqin Xiong1, Li Huang1, David W Herd1
1From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
Insights
Prednisolone treatment for Bell palsy in children aged 12-18 years is cost-effective, with a high probability of providing value. For younger children, the cost-effectiveness of prednisolone is less certain.
Area of Science:
- Pediatric Neurology
- Health Economics
- Clinical Pharmacology
Background:
- Bell palsy is a common cause of sudden neurologic dysfunction in children.
- The cost-effectiveness of prednisolone treatment for pediatric Bell palsy remains unestablished.
Purpose of the Study:
- To evaluate the cost-effectiveness of using prednisolone compared to placebo for treating Bell palsy in children.
- To inform healthcare stakeholders and policymakers on treatment decisions.
Main Methods:
- Secondary analysis of a randomized, placebo-controlled trial (BellPIC) involving 180 children.
- Economic evaluation over a 6-month period, measuring costs and quality-adjusted life-years (QALYs).
- Subgroup analysis conducted for age groups 12 to <18 years and <12 years.
Main Results:
- Prednisolone group cost: A$760; Placebo group cost: A$693 (difference A$66).
- Prednisolone group QALYs: 0.45; Placebo group QALYs: 0.44 (difference 0.01).
- Cost per additional QALY gained was A$6,625; 83% probability of cost-effectiveness at a threshold of A$50,000/QALY, primarily driven by older children (12-<18 years).
Conclusions:
- Prednisolone is likely cost-effective for treating Bell palsy in children aged 12 to <18 years.
- The cost-effectiveness for children younger than 12 years is less certain.
- Findings support informed decision-making for pediatric Bell palsy treatment.
Background And Objectives:
Bell palsy is the third most frequent diagnosis in children with sudden-onset neurologic dysfunction. The cost-effectiveness of treating Bell palsy with prednisolone in children is unknown. We aimed to assess the cost-effectiveness of prednisolone in treating Bell palsy in children compared with placebo.
Methods:
This economic evaluation was a prospectively planned secondary analysis of a double-blinded, randomized, placebo-controlled superiority trial (Bell Palsy in Children [BellPIC]) conducted from 2015 to 2020. The time horizon was 6 months since randomization. Children aged 6 months to <18 years who presented within 72 hours of onset of clinician-diagnosed Bell palsy and who completed the trial were included (N = 180). Interventions were oral prednisolone or taste-matched placebo administered for 10 days. Incremental cost-effectiveness ratio comparing prednisolone with placebo was estimated. Costs were considered from a health care sector perspective and included Bell palsy-related medication cost, doctor visits, and medical tests. Effectiveness was measured using quality-adjusted life-years (QALYs) based on Child Health Utility 9D. Nonparametric bootstrapping was performed to capture uncertainties. Prespecified subgroup analysis by age 12 to <18 years vs <12 years was conducted.
Results:
The mean cost per patient was A$760 in the prednisolone group and A$693 in the placebo group over the 6-month period (difference A$66, 95% CI -A$47 to A$179). QALYs over 6 months were 0.45 in the prednisolone group and 0.44 in the placebo group (difference 0.01, 95% CI -0.01 to 0.03). The incremental cost to achieve 1 additional recovery was estimated to be A$1,577 using prednisolone compared with placebo, and cost per additional QALY gained was A$6,625 using prednisolone compared with placebo. Given a conventional willingness-to-pay threshold of A$50,000 per QALY gained (equivalent to US$35,000 or £28,000), prednisolone is very likely cost-effective (probability is 83%). Subgroup analysis suggests that this was primarily driven by the high probability of prednisolone being cost-effective in children aged 12 to <18 years (probability is 98%) and much less so for those <12 years (probability is 51%).
Discussion:
This provides new evidence to stakeholders and policymakers when considering whether to make prednisolone available in treating Bell palsy in children aged 12 to <18 years.
Trial Registration Information:
Australian New Zealand Clinical Trials Registry ACTRN12615000563561.
