A cost-effectiveness analysis of inhaled corticosteroid delivery for children with asthma in the emergency department.
OBJECTIVE
To determine the clinical effectiveness and cost-effectiveness of 3 inhaled corticosteroid (ICS) delivery options for children with asthma treated in and discharged from the emergency department (ED).


METHODS
We conducted cost-effectiveness analysis using a decision tree to compare 3 ED-based ICS delivery options: usual care (recommending outpatient follow-up), prescribe (uniformly prescribing ICS), and dispense (uniformly dispensing ICS). Accounting for expected follow-up rates, prescription filling, and medication compliance, we compared projected rates of ED relapse visits and hospitalizations within 1 month of ED visit across all 3 arms. Direct and indirect costs were compared.


RESULTS
The model predicts that the rate of return to ED per 100 patients within 1 month of the ED visit was 10.6 visits for the usual care arm, 9.4 visits for the prescription arm, and 8.4 visits for the medication-dispensing arm. Rates of hospitalization per 100 patients were 2.4, 2.2, and 1.9, respectively. Direct costs per 100 patients for each arm were $23,400, $20,800, and $19,100, respectively. Including indirect costs related to missed parental work, total costs per 100 patients were $27,100, $22,000, and $20,100, respectively. Total cost savings per 100 patients comparing the usual care arm with the medication dispensing arm was $7000.


CONCLUSIONS
This decision analysis model suggests that uniform prescribing or dispensing of ICS at the time of ED visit for asthma may lead to a decreased number of ED visits and hospital admissions within 1 month of the sentinel ED visit and provides a substantial cost-savings.
Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA. andrewsan@musc.edu
Annie Lintzenich
AL
Andrews
Ronald J
RJ
Teufel
William T
WT
Basco
Kit N
KN
Simpson
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000191:economics*; D001249:Asthma / Q000188:drug therapy* / Q000191:economics; D002648:Child; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004636:Emergency Service, Hospital / Q000191:economics; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D010372:Pediatrics / Q000379:methods; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones