Combination treatment beneficial, cost-effective for children with bronchiolitis

**Sumner A. Pediatrics. 2010;126:623-631.**

A combination of nebulized epinephrine and oral dexamethasone appeared more effective and less expensive than other treatments for children with bronchilitis, Canadian researchers said.

Using results from the Canadian Bronchiolitis Epinephrine Steroid Trial (CanBEST), researchers from several institutions evaluated the cost-effectiveness and efficacy of combined treatment with nebulized epinephrine and oral dexamethasone compared with nebulized epinephrine alone, oral dexamethasone alone and no active treatment in outpatient infants with bronchiolitis.

The CanBEST trial involved 800 infants aged 6 weeks to 12 months with bronchiolitis who were seen in eight pediatric EDs during the 2004 to 2007 bronchiolitis seasons. Only infants with respiratory distress assessment index scores between 4 and 15 and a diagnosis of bronchiolitis warranted inclusion. Previous bronchodilator treatment; previous episodes of wheezing or diagnoses of wheezing; chronic cardiopulmonary disease; immunodeficiency or signs of severe distress excluded a child from participation.

The cost-effectiveness analysis was performed from societal and health care system perspectives and included all costs during 22 days after enrollment. Treatment efficacy was measured by duration of symptoms, such as feeding problems, sleeping problems, coughing and noisy breathing.

Data indicated that the average societal cost per patient was $1,210 for no active treatment (95% CI, 1,004-1,441), $1,360 for oral dexamethasone (95% CI, 1,124-1,624), $1,323 for nebulized epinephrine (95% CI, 1,093-1,571) and $1,115 for combination dexamethasone and epinephrine (95% CI, 919-1,325).

The average cost per patient for the health care system was $1,019 for no active treatment (95% CI, 826-1,232), $1,140 for oral dexamethasone (95% CI, 934-1,376), $1,090 for nebulized epinephrine (95% CI, 880-1,329) and $865 for combination therapy (95% CI, 690-1,062).

Results also revealed that the average time to symptom resolution was 12.69 days for no active treatment (95% CI, 12-13), 12.62 for dexamethasone (95% CI, 12-13), 13.02 for epinephrine (95% CI, 12-14) and 12.17 for combination therapy (95% CI, 11-13).

The researchers said combined treatment with epinephrine and dexamethasone appeared to decrease hospital admission rate by 35% relatively and 9% absolutely for the 7 days after study enrollment. Additionally, combination therapy reduced costs to the health care system by approximately $200 per patient.

“Although this is not a dramatic savings on an individual patient basis, given that bronchiolitis is the most common disease of the lower respiratory tract in the first year of life, such savings, on a wider scale, would be significant,” the researchers wrote. “At this point, the choice for decision-makers is whether to adopt this cost-effective approach now or await stronger evidence for dexamethasone and epinephrine in the treatment of bronchiolitis.”

Follow the PediatricSuperSite.com on Twitter.