Cost-effectiveness analysis of phenotypic-guided versus guidelines-guided bronchodilator therapy in viral bronchiolitis.
bronchiolitis
clinical practice guidelines
cost-effectiveness
health economics
phenotype
Journal
Pediatric pulmonology
ISSN: 1099-0496
Titre abrégé: Pediatr Pulmonol
Pays: United States
ID NLM: 8510590
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
received:
30
07
2020
revised:
10
09
2020
accepted:
09
10
2020
pubmed:
14
10
2020
medline:
10
6
2021
entrez:
13
10
2020
Statut:
ppublish
Résumé
Although recent evidence suggests that management of viral bronchiolitis requires something other than guidelines-guided therapy, there is a lack of evidence supporting the economic benefits of phenotypic-guided bronchodilator therapy for treating this disease. The aim of the present study was to compare the cost-effectiveness of phenotypic-guided versus guidelines-guided bronchodilator therapy in infants with viral bronchiolitis. A decision analysis model was developed to compare the cost-effectiveness of phenotypic-guided versus guidelines-guided bronchodilator therapy in infants with viral bronchiolitis. Phenotypic-guided bronchodilator therapy was defined as the administration of albuterol in infants exhibiting a profile of increased likelihood of response to bronchodilators. The effectiveness parameters and costs of the model were obtained from systematic reviews of the literature with meta-analyses and electronic medical records. The main outcome was the avoidance of hospital admission after initial care in the emergency department. Compared to guidelines-guided strategy, treating patients with viral bronchiolitis with the phenotypic-guided bronchodilator therapy strategy was associated with lower total costs (US$250.99; 95% uncertainty interval [UI]: US$184.37 to $336.51 vs. US$263.46; 95% UI: US$189.81 to $349.19 average cost per patient) and a higher probability of avoidance of hospital admission (0.7902; 95% UI: 0.7315-0.8356 vs. 0.7638; 95% UI: 0.7062-0.8201), thus leading to dominance. Results were robust to deterministic and probabilistic sensitivity analyses. Compared to guidelines-guided strategy, treating infants with viral bronchiolitis using the phenotypic-guided bronchodilator therapy strategy is a more cost-effective strategy, because it involves a lower probability of hospital admission at lower total treatment costs.
Identifiants
pubmed: 33049126
doi: 10.1002/ppul.25114
pmc: PMC8850934
mid: NIHMS1778019
doi:
Substances chimiques
Bronchodilator Agents
0
Albuterol
QF8SVZ843E
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
187-195Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL141237
Pays : United States
Organisme : NHLBI NIH HHS
ID : R56 HL141237
Pays : United States
Informations de copyright
© 2020 Wiley Periodicals LLC.
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