Cost‐effectiveness analysis of phenotypic‐guided versus guidelines‐guided bronchodilator therapy in viral bronchiolitis

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 stud...

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Veröffentlicht in:Pediatric pulmonology 2021-01, Vol.56 (1), p.187-195
Hauptverfasser: Rodriguez‐Martinez, Carlos E., Nino, Gustavo, Castro‐Rodriguez, Jose A., Perez, Geovanny F., Sossa‐Briceño, Monica P., Buendia, Jefferson A.
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container_end_page 195
container_issue 1
container_start_page 187
container_title Pediatric pulmonology
container_volume 56
creator Rodriguez‐Martinez, Carlos E.
Nino, Gustavo
Castro‐Rodriguez, Jose A.
Perez, Geovanny F.
Sossa‐Briceño, Monica P.
Buendia, Jefferson A.
description 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.
doi_str_mv 10.1002/ppul.25114
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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.</description><identifier>ISSN: 8755-6863</identifier><identifier>EISSN: 1099-0496</identifier><identifier>DOI: 10.1002/ppul.25114</identifier><identifier>PMID: 33049126</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Administration, Inhalation ; Albuterol - therapeutic use ; bronchiolitis ; Bronchiolitis - therapy ; Bronchiolitis - virology ; Bronchiolitis, Viral - drug therapy ; Bronchitis ; Bronchodilator Agents - therapeutic use ; Bronchodilators ; Clinical practice guidelines ; Cost analysis ; Cost-Benefit Analysis ; cost‐effectiveness ; Electronic Health Records ; Emergency Service, Hospital ; Genotype &amp; phenotype ; Health Care Costs ; Health economics ; Hospitalization ; Humans ; Infant ; phenotype ; Respiratory therapy</subject><ispartof>Pediatric pulmonology, 2021-01, Vol.56 (1), p.187-195</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4484-10f1c2c026f911352ecaced7854afb5a4968c2f7dfce9668d084eb20308bb6493</citedby><cites>FETCH-LOGICAL-c4484-10f1c2c026f911352ecaced7854afb5a4968c2f7dfce9668d084eb20308bb6493</cites><orcidid>0000-0002-0708-4281 ; 0000-0003-2404-6612 ; 0000-0001-8621-6109 ; 0000-0003-2560-6693</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fppul.25114$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fppul.25114$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33049126$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rodriguez‐Martinez, Carlos E.</creatorcontrib><creatorcontrib>Nino, Gustavo</creatorcontrib><creatorcontrib>Castro‐Rodriguez, Jose A.</creatorcontrib><creatorcontrib>Perez, Geovanny F.</creatorcontrib><creatorcontrib>Sossa‐Briceño, Monica P.</creatorcontrib><creatorcontrib>Buendia, Jefferson A.</creatorcontrib><title>Cost‐effectiveness analysis of phenotypic‐guided versus guidelines‐guided bronchodilator therapy in viral bronchiolitis</title><title>Pediatric pulmonology</title><addtitle>Pediatr Pulmonol</addtitle><description>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. 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Nino, Gustavo ; Castro‐Rodriguez, Jose A. ; Perez, Geovanny F. ; Sossa‐Briceño, Monica P. ; Buendia, Jefferson A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4484-10f1c2c026f911352ecaced7854afb5a4968c2f7dfce9668d084eb20308bb6493</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Administration, Inhalation</topic><topic>Albuterol - therapeutic use</topic><topic>bronchiolitis</topic><topic>Bronchiolitis - therapy</topic><topic>Bronchiolitis - virology</topic><topic>Bronchiolitis, Viral - drug therapy</topic><topic>Bronchitis</topic><topic>Bronchodilator Agents - therapeutic use</topic><topic>Bronchodilators</topic><topic>Clinical practice guidelines</topic><topic>Cost analysis</topic><topic>Cost-Benefit Analysis</topic><topic>cost‐effectiveness</topic><topic>Electronic Health Records</topic><topic>Emergency Service, Hospital</topic><topic>Genotype &amp; phenotype</topic><topic>Health Care Costs</topic><topic>Health economics</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Infant</topic><topic>phenotype</topic><topic>Respiratory therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rodriguez‐Martinez, Carlos E.</creatorcontrib><creatorcontrib>Nino, Gustavo</creatorcontrib><creatorcontrib>Castro‐Rodriguez, Jose A.</creatorcontrib><creatorcontrib>Perez, Geovanny F.</creatorcontrib><creatorcontrib>Sossa‐Briceño, Monica P.</creatorcontrib><creatorcontrib>Buendia, Jefferson A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatric pulmonology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rodriguez‐Martinez, Carlos E.</au><au>Nino, Gustavo</au><au>Castro‐Rodriguez, Jose A.</au><au>Perez, Geovanny F.</au><au>Sossa‐Briceño, Monica P.</au><au>Buendia, Jefferson A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost‐effectiveness analysis of phenotypic‐guided versus guidelines‐guided bronchodilator therapy in viral bronchiolitis</atitle><jtitle>Pediatric pulmonology</jtitle><addtitle>Pediatr Pulmonol</addtitle><date>2021-01</date><risdate>2021</risdate><volume>56</volume><issue>1</issue><spage>187</spage><epage>195</epage><pages>187-195</pages><issn>8755-6863</issn><eissn>1099-0496</eissn><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. 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subjects Administration, Inhalation
Albuterol - therapeutic use
bronchiolitis
Bronchiolitis - therapy
Bronchiolitis - virology
Bronchiolitis, Viral - drug therapy
Bronchitis
Bronchodilator Agents - therapeutic use
Bronchodilators
Clinical practice guidelines
Cost analysis
Cost-Benefit Analysis
cost‐effectiveness
Electronic Health Records
Emergency Service, Hospital
Genotype & phenotype
Health Care Costs
Health economics
Hospitalization
Humans
Infant
phenotype
Respiratory therapy
title Cost‐effectiveness analysis of phenotypic‐guided versus guidelines‐guided bronchodilator therapy in viral bronchiolitis
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