Oral Ondansetron Administration in Emergency Departments to Children with Gastroenteritis: An Economic Analysis
Background:
The use of antiemetics for children with vomiting is one of the most controversial decisions in the treatment of gastroenteritis in developed countries. Ondansetron, a selective serotonin receptor antagonist, has been found to be effective in improving the success of oral rehydration therapy. However, North American and European clinical practice guidelines continue to recommend against its use, stating that evidence of cost savings would be required to support ondansetron administration. Thus, an economic analysis of the emergency department administration of ondansetron was conducted. The primary objective was to conduct a cost analysis of the routine administration of ondansetron in both the United States and Canada.
Methods and Findings:
A cost analysis evaluated oral ondansetron administration to children presenting to emergency departments with vomiting and dehydration secondary to gastroenteritis from a societal and health care payer's perspective in both the US and Canada. A decision tree was developed that incorporated the frequency of vomiting, intravenous insertion, hospitalization, and emergency department revisits. Estimates of the monetary costs associated with ondansetron use, intravenous rehydration, and hospitalization were derived from administrative databases or emergency department use. The economic burden in children administered ondansetron plus oral rehydration therapy was compared to those not administered ondansetron employing deterministic and probabilistic simulations. We estimated the costs or savings to society and health care payers associated with the routine administration of ondansetron. Sensitivity analyses considered variations in costs, treatment effects, and exchange rates. In the US the administration of ondansetron to eligible children would prevent approximately 29,246 intravenous insertions and 7,220 hospitalizations annually. At the current average wholesale price, its routine administration to eligible children would annually save society US$65.6 million (US$49.1–US$81.1) and health care payers US$61.1 million (US$46.2–US$76.3). In Canada the administration of ondansetron to eligible children would prevent 4,065 intravenous insertions and 1,003 hospitalizations annually. Its routine administration would annually save society CDN$1.72 million (CDN$1.15–CDN$1.89) and the health care system CDN$1.18 million (CDN$0.88–CDN$1.41).
Conclusions:
In countries where intravenous rehydration is often employed, the emergency department administration of oral ondansetron to children with dehydration and vomiting secondary to gastroenteritis results in significant monetary savings compared to a no-ondansetron policy.
: Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Oral Ondansetron Administration in Emergency Departments to Children with Gastroenteritis: An Economic Analysis. PLoS Med 7(10): e32767. doi:10.1371/journal.pmed.1000350
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1000350
Souhrn
Background:
The use of antiemetics for children with vomiting is one of the most controversial decisions in the treatment of gastroenteritis in developed countries. Ondansetron, a selective serotonin receptor antagonist, has been found to be effective in improving the success of oral rehydration therapy. However, North American and European clinical practice guidelines continue to recommend against its use, stating that evidence of cost savings would be required to support ondansetron administration. Thus, an economic analysis of the emergency department administration of ondansetron was conducted. The primary objective was to conduct a cost analysis of the routine administration of ondansetron in both the United States and Canada.
Methods and Findings:
A cost analysis evaluated oral ondansetron administration to children presenting to emergency departments with vomiting and dehydration secondary to gastroenteritis from a societal and health care payer's perspective in both the US and Canada. A decision tree was developed that incorporated the frequency of vomiting, intravenous insertion, hospitalization, and emergency department revisits. Estimates of the monetary costs associated with ondansetron use, intravenous rehydration, and hospitalization were derived from administrative databases or emergency department use. The economic burden in children administered ondansetron plus oral rehydration therapy was compared to those not administered ondansetron employing deterministic and probabilistic simulations. We estimated the costs or savings to society and health care payers associated with the routine administration of ondansetron. Sensitivity analyses considered variations in costs, treatment effects, and exchange rates. In the US the administration of ondansetron to eligible children would prevent approximately 29,246 intravenous insertions and 7,220 hospitalizations annually. At the current average wholesale price, its routine administration to eligible children would annually save society US$65.6 million (US$49.1–US$81.1) and health care payers US$61.1 million (US$46.2–US$76.3). In Canada the administration of ondansetron to eligible children would prevent 4,065 intravenous insertions and 1,003 hospitalizations annually. Its routine administration would annually save society CDN$1.72 million (CDN$1.15–CDN$1.89) and the health care system CDN$1.18 million (CDN$0.88–CDN$1.41).
Conclusions:
In countries where intravenous rehydration is often employed, the emergency department administration of oral ondansetron to children with dehydration and vomiting secondary to gastroenteritis results in significant monetary savings compared to a no-ondansetron policy.
: Please see later in the article for the Editors' Summary
Zdroje
1. GuarinoA
AlbanoF
AshkenaziS
GendrelD
HoekstraJH
2008 European Society for Paediatric Gastroenterology, Hepatology, and Nutrition/European Society for Paediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: executive summary. J Pediatr Gastroenterol Nutr 46 619 621
2. KingCK
GlassR
BreseeJS
DugganC
2003 Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep 52 1 16
3. ReisEC
GoeppJG
KatzS
SantoshamM
1994 Barriers to use of oral rehydration therapy. Pediatrics 93 708 711
4. OzuahPO
AvnerJR
SteinRE
2002 Oral rehydration, emergency physicians, and practice parameters: a national survey. Pediatrics 109 259 261
5. LiST
DiGiuseppeDL
ChristakisDA
2003 Antiemetic use for acute gastroenteritis in children. Arch Pediatr Adolesc Med 157 475 479
6. KwonKT
RudkinSE
LangdorfMI
2002 Antiemetic use in pediatric gastroenteritis: a national survey of emergency physicians, pediatricians, and pediatric emergency physicians. Clin Pediatr (Phila) 41 641 652
7. StarkePR
WeaverJ
ChowdhuryBA
2005 Boxed warning added to promethazine labeling for pediatric use. N Engl J Med 352 2653
8. FreedmanSB
AdlerM
SeshadriR
PowellEC
2006 Oral ondansetron for gastroenteritis in a pediatric emergency department. N Engl J Med 354 1698 1705
9. RamsookC
Sahagun-CarreonI
KozinetzCA
Moro-SutherlandD
2002 A randomized clinical trial comparing oral ondansetron with placebo in children with vomiting from acute gastroenteritis. Ann Emerg Med 39 397 403
10. RoslundG
HeppsTS
McQuillenKK
2008 The role of oral ondansetron in children with vomiting as a result of acute gastritis/gastroenteritis who have failed oral rehydration therapy: a randomized controlled trial. Ann Emerg Med 52 22 29 e26
11. StorkCM
BrownKM
ReillyTH
SecretiL
BrownLH
2006 Emergency department treatment of viral gastritis using intravenous ondansetron or dexamethasone in children. Acad Emerg Med 13 1027 1033
12. ReevesJJ
ShannonMW
FleisherGR
2002 Ondansetron decreases vomiting associated with acute gastroenteritis: a randomized, controlled trial. Pediatrics 109 e62
13. CubedduLX
TrujilloLM
TalmaciuI
GonzalezV
GuariguataJ
1997 Antiemetic activity of ondansetron in acute gastroenteritis. Aliment Pharmacol Ther 11 185 191
14. DeCampLR
ByerleyJS
DoshiN
SteinerMJ
2008 Use of antiemetic agents in acute gastroenteritis: a systematic review and meta-analysis. Arch Pediatr Adolesc Med 162 858 865
15. National Collaborating Centre for Women's and Children's Health Diarrhoea and vomiting caused by gastroenteritis: diagnosis, assessment and management in children younger than 5 years London National Institute for Health and Clinical Excellence
16. SzajewskaH
Gieruszczak-BialekD
DylagM
2007 Meta-analysis: ondansetron for vomiting in acute gastroenteritis in children. Aliment Pharmacol Ther 25 393 400
17. AlhashimiD
Al-HashimiH
FedorowiczZ
2009 Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database Syst Rev CD005506
18. DrummondMF
JeffersonTO
1996 Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ 313 275 283
19. Statistics Canada. Age and sex, 2006 count for both sexes, for Canada, provinces and territories - 100% data. Available at: http://www12.statcan.gc.ca/census-recensement/2006/dp-pd/tbt/Rp-eng.cfm?LANG=E&APATH=3&DETAIL=0&DIM=0&FL=A&FREE=0&GC=0&GID=0&GK=0&GRP=1&PID=88977&PRID=0&PTYPE=88971,97154&S=0&SHOWALL=0&SUB=0&Temporal=2006&THEME=66&VID=0&VNAMEE=&VNAMEF=. Accessed 15 November 2008
20. TiederJS
RobertsonA
GarrisonMM
2009 Pediatric hospital adherence to the standard of care for acute gastroenteritis. Pediatrics 124 e1081 1087
21. AvendanoP
MatsonDO
LongJ
WhitneyS
MatsonCC
1993 Costs associated with office visits for diarrhea in infants and toddlers. Pediatric Infectious Disease Journal 12 897 902
22. FersonMJ
StringfellowS
McPhieK
McIverCJ
SimosA
1997 Longitudinal study of rotavirus infection in child-care centres. Journal of Paediatrics & Child Health 33 157 160
23. CoffinSE
ElserJ
MarchantC
SawyerM
PollaraB
2006 Impact of acute rotavirus gastroenteritis on pediatric outpatient practices in the United States. Pediatric Infectious Disease Journal 25 584 589
24. HardyAM
LairsonDR
MorrowAL
1994 Costs associated with gastrointestinal-tract illness among children attending day-care centers in Houston, Texas. Pediatrics 94 1091 1093
25. HuninkM
GlasziouP
SiegelJ
WeeksJ
PliskinJ
2001 Decision making in health and medicine Cambridge Cambridge University Press
26. U.S. Department of Labor, Bureau of Labor Statistics. Available: www.bls.gov/cpid07av.pdf. Accessed 7 June 2010
27. U.S. Department of Labor, Bureau of Labor Statistics. Available: www.bls.gov/cpid08av.pdf. Accessed 7 June 2010
28. Statistics Canada. Consumer Price Index, health and personal care, by province. Available: www40.statcan.gc.ca/l01/cst01/econ161a-eng.htm. Accessed 16 September 2010
29. Physicians desk reference editorial staff 2008 Red book: pharmacy's fundamental reference. 110th edition Montvale (New Jersey) Thomson Healthcare
30. TunisSL
2009 A cost-effectiveness analysis to illustrate the impact of cost definitions on results, interpretations and comparability of pharmacoeconomic studies in the US. Pharmacoeconomics 27 735 744
31. ChangP
OkamotoM
ChenJ
FrameD
2005 Cost-effectiveness analysis of ondansetron and prochlorperazine for the prevention of postoperative nausea and vomiting. J Manag Care Pharm 11 317 321
32. Yale WassermanDMD
2008 Physicians' fee reference 2008. 25th edition Milwaukee (Wisconsin) Medical Publishers, Ltd
33. YeeEL
StaatMA
AzimiP
BernsteinDI
WardRL
2008 Burden of rotavirus disease among children visiting pediatric emergency departments in Cincinnati, Ohio, and Oakland, California, in 1999–2000. Pediatrics 122 971 977
34. US Bureau of Labor and Statistics 2006 National Compensation Survey, June 2006. Available: http://www.bls.gov/NCS/. Accessed 7 November 2008
35. CANSIM database Table 281-0030 2010 Average hourly earning for employees paid by the hour (SEPH), unadjusted for seasonal variation for selected industries classified using the North American Industry Classification System (NAICS), annual (dollars). Available: http://cansim2.statcan.ca/cgi-win/cnsmcgi.exe?Lang=E&RootDir=CII/&ResultTemplate=CII/CII_pick&Array_Pick=1&ArrayId=281-0030
36. CarrollAE
DownsSM
2009 Improving decision analyses: parent preferences (utility values) for pediatric health outcomes. J Pediatr 155 21 25
37. Committee on Infectious D, American Academy of P 2009 Prevention of rotavirus disease: updated guidelines for use of rotavirus vaccine. Pediatrics 123 1412 1420
38. WiddowsonMA
MeltzerMI
ZhangX
BreseeJS
ParasharUD
2007 Cost-effectiveness and potential impact of rotavirus vaccination in the United States. Pediatrics 119 684 697
39. WHO/UNICEF 2004 Joint statement: clinical management of acute diarrhoea (WHO/FCH/CAH/04.07) Geneva and New York World Health Organization, Department of Child and Adolescent Health and Development, and United Nations Children's Fund, Programme Division
40. WalkerCL
BlackRE
2010 Zinc for the treatment of diarrhoea: effect on diarrhoea morbidity, mortality and incidence of future episodes. Int J Epidemiol 39 Suppl 1 i63 i69
41. SturmJJ
HirshDA
SchweickertA
MasseyR
SimonHK
2009 Ondansetron use in the pediatric emergency department and effects on hospitalization and return rates: are we masking alternative diagnoses? Ann Emerg Med 55 415 422
42. GavaganT
SchumannSA
2009 This antiemetic may help kids skip that trip to the hospital. J Fam Pract 58 85 88
43. PasrichaPJ
2006 Treatment of disorders of bowel motility and water flux; antiemetics; agents used in biliary and pancreatic disease.
BruntonLL
LazoJS
ParkerKL
Goodman & Gilman's the pharmacological basis of therapeutics New York McGraw-Hill Companies, Inc 983 1008
44. GenerB
BurnsJM
GriffinS
BoyerEW
2010 Administration of ondansetron is associated with lethal outcome. Pediatrics 125 e1514 1517
45. LeeCY
RatnapalanS
ThompsonM
NathanPC
ClossJ
2010 Unusual reactions to 5-HT3 receptor antagonists in a child with rhabdomyosarcoma. Can J Clin Pharmacol 17 e1 4
46. SantoshamM
2002 Oral rehydration therapy: reverse transfer of technology. Arch Pediatr Adolesc Med 156 1177 1179
47. HartlingL
BellemareS
WiebeN
RussellK
KlassenTP
2006 Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database Syst Rev 3 CD004390
48. KarpasA
FinkelsteinM
ReidS
2009 Parental preference for rehydration method for children in the emergency department. Pediatr Emerg Care 25 301 306
Štítky
Interné lekárstvoČlánok vyšiel v časopise
PLOS Medicine
2010 Číslo 10
- Statinová intolerance
- Očkování proti virové hemoragické horečce Ebola experimentální vakcínou rVSVDG-ZEBOV-GP
- Co dělat při intoleranci statinů?
- Pleiotropní účinky statinů na kardiovaskulární systém
- DESATORO PRE PRAX: Aktuálne odporúčanie ESPEN pre nutričný manažment u pacientov s COVID-19
Najčítanejšie v tomto čísle
- Epigenetic Epidemiology of Common Complex Disease: Prospects for Prediction, Prevention, and Treatment
- Editors, Publishers, Impact Factors, and Reprint Income
- Systematic Evaluation of Serotypes Causing Invasive Pneumococcal Disease among Children Under Five: The Pneumococcal Global Serotype Project
- The Persisting Burden of Intracerebral Haemorrhage: Can Effective Treatments Be Found?