Cost-effectiveness analysis of phenotypic-guided versus guidelines-guided bronchodilator therapy in viral bronchiolitis
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Pediatric Pulmonology, 1099-0496, 2020
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Wiley-Blackwell
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Abstract
Objectives
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.
Methods
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.
Results
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.
Conclusions
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.
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Keywords
Bronchiolitis, Clinical practice guidelines, Cost-effectiveness, Health economics, Phenotype