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Efficacy and cost effectiveness of inhaled steroids in asthma in a developing country
1Asiri Hospital, Colombo, Sri Lanka.
Insights
Inhaled steroids significantly improve clinical outcomes for children with troublesome wheezing. This asthma treatment is highly cost-effective, even for developing nations.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Health Economics
Background:
- Childhood asthma and troublesome wheezing present significant clinical and economic burdens.
- Inhaled corticosteroids are a common treatment, but their cost-effectiveness in pediatric populations, particularly in resource-limited settings, requires thorough evaluation.
Purpose of the Study:
- To assess the clinical efficacy of inhaled steroids in children experiencing troublesome wheezing.
- To evaluate the cost-effectiveness of inhaled steroid treatment for childhood asthma from a family's perspective.
Main Methods:
- A semiprospective clinical trial was conducted with 86 children, utilizing a within-patient control design.
- Clinical efficacy was measured by improvements in school attendance, hospitalizations, breakthrough wheezing, and acute severe attacks.
- Cost-effectiveness was determined using a cost-of-illness framework, comparing family expenditures before and after treatment.
Main Results:
- A highly significant improvement in clinical parameters was observed, confirming the efficacy of inhaled steroids.
- Mean monthly family costs decreased dramatically from Rs 2652.33 before treatment to Rs 449.42 after initiating inhaled steroid prophylaxis.
- The cost utility value per unit of satisfaction significantly reduced from Rs 255.54 to Rs 5.42 post-treatment.
Conclusions:
- Inhaled steroid treatment demonstrates significant clinical efficacy for childhood asthma and troublesome wheezing.
- The treatment is highly cost-effective, offering substantial financial savings for families.
- Inhaled corticosteroid prophylaxis is a rational and economically viable treatment option for childhood asthma, even in developing countries facing financial constraints.
Abstract:
Eighty six children with troublesome wheezing were studied, in a semiprospective clinical trial with the patients acting as their own controls, to assess the efficacy and cost effectiveness of inhaled steroids. Improvement in school attendance, hospitalisations, breakthrough wheezing, and acute severe attacks were used to assess clinical efficacy. Expenditure for the family, on a cost of illness framework, before and after treatment, was used to estimate cost effectiveness. Highly significant numbers of patients showed improvement in clinical parameters, confirming efficacy. Mean monthly cost before inhaled steroid treatment was Rs 2652.33 (36.33 pounds) and Rs 449.42 (6.16 pounds) after starting treatment. The mean cost per unit satisfaction (cost utility value) which was Rs 255.54 (3.50 pounds) before starting prophylaxis came down to Rs 5.42 (0.07 pound) after starting treatment. There are no previous reports of cost-benefit assessment of inhaled steroids in childhood asthma. It is concluded that, even for developing countries with financial constraints, inhaled steroid treatment for prophylaxis of asthma is a cost effective and rational form of treatment.