title: Cost-effectiveness of epinephrine and dexamethasone in children with bronchiolitis.
abstract: OBJECTIVE
  Using data from the Canadian Bronchiolitis Epinephrine Steroid Trial we assessed the cost-effectiveness of treatments with epinephrine and dexamethasone for infants between 6 weeks and 12 months of age with bronchiolitis.
  
  
  METHODS
  An economic evaluation was conducted from both the societal and health care system perspectives including all costs during 22 days after enrollment. The effectiveness of therapy was measured by the duration of symptoms of feeding problems, sleeping problems, coughing, and noisy breathing. Comparators were nebulized epinephrine plus oral dexamethasone, nebulized epinephrine alone, oral dexamethasone alone, and no active treatment. Uncertainty around estimates was assessed through nonparametric bootstrapping.
  
  
  RESULTS
  The combination of nebulized epinephrine plus oral dexamethasone was dominant over the other 3 comparators in that it was both the most effective and least costly. Average societal costs were $1115 (95% credible interval [CI]: 919-1325) for the combination therapy, $1210 (95% CI: 1004-1441) for no active treatment, $1322 (95% CI: 1093-1571) for epinephrine alone, and $1360 (95% CI: 1124-1624) for dexamethasone alone. The average time to curtailment of all symptoms was 12.1 days (95% CI: 11-13) for the combination therapy, 12.7 days (95% CI: 12-13) for no active treatment, 13.0 days (95% CI: 12-14) for epinephrine alone, and 12.6 days (95% CI: 12-13) for dexamethasone alone.
  
  
  CONCLUSIONS
  Treating infants with bronchiolitis with a combination of nebulized epinephrine plus oral dexamethasone is the most cost-effective treatment option, because it is the most effective in controlling symptoms and is associated with the least costs.
authors.affiliation: Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, and Department of Epidemiology and Community Medicine, University of Ottawa, 401 Smyth Ave, Ottawa, Ontario, Canada K1H 8L1.
authors.forename: Amanda
authors.initials: A
authors.lastname: Sumner
authors.forename: Douglas
authors.initials: D
authors.lastname: Coyle
authors.forename: Craig
authors.initials: C
authors.lastname: Mitton
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Hema
authors.initials: H
authors.lastname: Patel
authors.forename: Terry P
authors.initials: TP
authors.lastname: Klassen
authors.forename: Rhonda
authors.initials: R
authors.lastname: Correll
authors.forename: Serge
authors.initials: S
authors.lastname: Gouin
authors.forename: Maala
authors.initials: M
authors.lastname: Bhatt
authors.forename: Gary
authors.initials: G
authors.lastname: Joubert
authors.forename: Karen J L
authors.initials: KJ
authors.lastname: Black
authors.forename: Troy
authors.initials: T
authors.lastname: Turner
authors.forename: Sandra
authors.initials: S
authors.lastname: Whitehouse
authors.forename: Amy C
authors.initials: AC
authors.lastname: Plint
mesh_terms: D000284:Administration, Oral; D001988:Bronchiolitis / Q000188:drug therapy* / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D003907:Dexamethasone / Q000008:administration & dosage / Q000191:economics*; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage / Q000191:economics*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D009330:Nebulizers and Vaporizers; D009864:Ontario; D016032:Randomized Controlled Trials as Topic
chemical_list: D001993:Bronchodilator Agents; D005938:Glucocorticoids; D003907:Dexamethasone; D004837:Epinephrine