A Cost-Effectiveness Analysis of Inhaled Corticosteroid Delivery for Children with Asthma in the Emergency Department
The Journal of Pediatrics, 06/21/2012
Andrews AL et al. – This decision analysis model suggests that uniform prescribing or dispensing of inhaled corticosteroid (ICS) at the time of emergency department (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.Methods
- The authors 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, they compared projected rates of ED relapse visits and hospitalizations within 1 month of ED visit across all 3 arms.
- 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 $23400, $20800, and $19100, respectively.
- Including indirect costs related to missed parental work, total costs per 100 patients were $27100, $22000, and $20100, respectively.
- Total cost savings per 100 patients comparing the usual care arm with the medication dispensing arm was $7000.