Clinical course and cost assessment of infants with a first episode of acute bronchiolitis presenting to the emergency department: Data from the GUERANDE clinical trial.
asthma & early wheeze
bronchiolitis
economic evaluation
epidemiology
Journal
Pediatric pulmonology
ISSN: 1099-0496
Titre abrégé: Pediatr Pulmonol
Pays: United States
ID NLM: 8510590
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
revised:
15
07
2021
received:
12
11
2020
accepted:
15
07
2021
pubmed:
14
9
2021
medline:
25
12
2021
entrez:
13
9
2021
Statut:
ppublish
Résumé
Bronchiolitis is the leading cause of hospitalization for infants but its economic burden is not well documented. Our objective was to describe the clinical evolution and to assess the 1-month cost of a first episode of acute bronchiolitis presenting to the emergency department (ED). Our study was an epidemiologic analysis and a cost study of the cohort drawn from the clinical trial GUERANDE, conducted in 24 French pediatric EDs. Infants of 6 weeks to 12 months of age presenting at pediatric EDs with a first episode of bronchiolitis were eligible. The costs considered were collected from a societal viewpoint, according to the recommendations of the French National Health Authority. A total of 777 infants were included with a median age of 4 months. A total of 57% were hospitalized during the month following the first consultation in the ED, including 28 (3.6%) in an intensive care unit. The mean length of stay was 4.2 days (SD = 3.7). The average time to relief of all symptoms was 13 days (SD = 7). Average total cost per patient was €1919 (95% confidence interval: 1756-2138) from a societal perspective, mostly due to hospitalization cost. The estimated annual cost of bronchiolitis in infants was evaluated to be between €160 and €273 million in France. Bronchiolitis represent a high cost for the health care system and broadly for society, with hospitalizations costs being the main cost driver. Thus significant investments should be made to develop innovative therapies, to reduce the number of hospitalizations and length of stay.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3802-3812Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Haute Autorité de Santé (HAS-France). Prise en charge du premier épisode de bronchiolite aiguë chez le nourrisson de moins de 12 mois. 2019.
Hall CB, Weinberg GA, Iwane MK, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009;360(6):588-598.
Meissner HC. Viral bronchiolitis in children. N Engl J Med. 2016;374(1):62-72.
Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014;134(5):e1474-e1502.
Caffrey Osvald E, Clarke JR. NICE clinical guideline: bronchiolitis in children. Arch Dis Child Educ Pract Ed. 2016;101(1):46-48.
Gajdos V, Katsahian S, Beydon N, et al. Effectiveness of chest physiotherapy in infants hospitalized with acute bronchiolitis: a multicenter, randomized, controlled trial. PLoS Med. 2010;7(9):e1000345.
Farley R, Spurling GKP, Eriksson L, Del, Mar CB. Antibiotics for bronchiolitis in children under two years of age. Cochrane Database Syst Rev. 2014;10:CD005189.
Pelletier AJ, Mansbach JM, Camargo CA. Direct medical costs of bronchiolitis hospitalizations in the United States. Pediatrics. 2006;118(6):2418-2423.
Fujiogi M, Goto T, Yasunaga H, et al. Trends in bronchiolitis hospitalizations in the United States: 2000-2016. Pediatrics. 2019;144(6):e20192614.
Che D, Nicolau J, Bergounioux J, Perez T, Bitar D. Bronchiolitis among infants under 1 year of age in France: epidemiology and factors associated with mortality. Arch Pediatr Organe Off Soc Francaise Pediatr. 2012;19(7):700-706.
Angoulvant F, Bellêttre X, Milcent K, et al. Effect of nebulized hypertonic saline treatment in emergency departments on the hospitalization rate for acute bronchiolitis: a randomized clinical trial. JAMA Pediatr. 2017;171(8):e171333.
Haute Autorité de Santé (HAS-France). Choix méthodologiques pour l'évaluation économique à la HAS. 2011.
The R Core Team. R: The R Project for Statistical Computing. 2016. Accessed October 5 2016. https://www.r-project.org/
Muñoz-Quiles C, López-Lacort M, Úbeda-Sansano I, et al. Population-based analysis of bronchiolitis epidemiology in Valencia, Spain. Pediatr Infect Dis J. 2016;35(3):275-280.
Cunningham S, Rodriguez A, Boyd KA, McIntosh E, Lewis SC, BIDS Collaborators Group. Bronchiolitis of Infancy Discharge Study (BIDS): a multicentre, parallel-group, double-blind, randomised controlled, equivalence trial with economic evaluation. Health Technol Assess Winch Engl. 2015;19(71):1-172.
Wu S, Baker C, Lang ME, et al. Nebulized hypertonic saline for bronchiolitis: a randomized clinical trial. JAMA Pediatr. 2014;168(7):657-663.
Henrickson KJ, Hoover S, Kehl KS, Hua W. National disease burden of respiratory viruses detected in children by polymerase chain reaction. Pediatr Infect Dis J. 2004;23(1 Suppl):S11-S18.
Everard ML, Hind D, Ugonna K, et al. Saline in acute bronchiolitis RCT and economic evaluation: hypertonic saline in acute bronchiolitis-randomised controlled trial and systematic review. Health Technol Assess Winch Engl. 2015;19(66):1-130.
Gong C, Byczkowski T, McAneney C, Goyal MK, Florin TA. Emergency department management of bronchiolitis in the United States. Pediatr Emerg Care. 2017;35:5-11.
Garcia-Marcos L, Valverde-Molina J, Pavlovic-Nesic S, et al. Pediatricians' attitudes and costs of bronchiolitis in the emergency department: a prospective multicentre study. Pediatr Pulmonol. 2014;49(10):1011-1019.
Jacobs JD, Foster M, Wan J, Pershad J. 7% Hypertonic saline in acute bronchiolitis: a randomized controlled trial. Pediatrics. 2014;133(1):e8-e13.
Florin TA, Shaw KN, Kittick M, Yakscoe S, Zorc JJ. Nebulized hypertonic saline for bronchiolitis in the emergency department: a randomized clinical trial. JAMA Pediatr. 2014;168(7):664-670.
Damore D, Mansbach JM, Clark S, Ramundo M, Camargo CA. Prospective multicenter bronchiolitis study: predicting intensive care unit admissions. Acad Emerg Med. 2008;15(10):887-894.
Unger S, Cunningham S. Effect of oxygen supplementation on length of stay for infants hospitalized with acute viral bronchiolitis. Pediatrics. 2008;121(3):470-475.
Brooks CG, Harrison WN, Ralston SL. Association between hypertonic saline and hospital length of stay in acute viral bronchiolitis: a reanalysis of 2 meta-analyses. JAMA Pediatr. 2016;170(6):577-584.
Heikkilä P, Forma L, Korppi M. Hospitalisation costs for infant bronchiolitis are up to 20 times higher if intensive care is needed. Acta Paediatr Oslo Nor 1992. 2015;104(3):269-273.
Heikkilä P, Mecklin M, Korppi M. The cost-effectiveness of hypertonic saline inhalations for infant bronchiolitis: a decision analysis. World J Pediatr WJP. 2018;14(1):26-34.
Miedema CJ, Kors AW, Tjon A, Ten WE, Kimpen JL. Medical consumption and socioeconomic effects of infection with respiratory syncytial virus in The Netherlands. Pediatr Infect Dis J. 2001;20(2):160-163.
Stang P, Brandenburg N, Carter B. The economic burden of respiratory syncytial virus-associated bronchiolitis hospitalizations. Arch Pediatr Adolesc Med. 2001;155(1):95-96.
Leidy NK, Margolis MK, Marcin JP, et al. The impact of severe respiratory syncytial virus on the child, caregiver, and family during hospitalization and recovery. Pediatrics. 2005;115(6):1536-1546.