Cost-effectiveness of epinephrine and dexamethasone in children with bronchiolitis.
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.
Sumner
Amanda
A
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.
Coyle
Douglas
D
Mitton
Craig
C
Johnson
David W
DW
Patel
Hema
H
Klassen
Terry P
TP
Correll
Rhonda
R
Gouin
Serge
S
Bhatt
Maala
M
Joubert
Gary
G
Black
Karen J L
KJ
Turner
Troy
T
Whitehouse
Sandra
S
Plint
Amy C
AC
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
D001993:Bronchodilator Agents; D005938:Glucocorticoids; D003907:Dexamethasone; D004837:Epinephrine