This cost-effectiveness analysis compared 3 ED-based inhaled corticosteroid (ICS) delivery options: - usual care (recommending outpatient follow-up)
- prescribe (uniformly prescribing ICS)
- dispense (uniformly dispensing ICS)
Rates of ED relapse visits and hospitalizations within 1 month of ED visit were compared across all 3 arms.
Rate of return to ED per 100 patients within 1 month of the ED visit was 10 visits for the usual care arm, 9 visits for the prescription arm, and 8 visits for the medication-dispensing arm. Rates of hospitalization per 100 patients were 2.4, 2.2, and 1.9, respectively.
Including indirect costs related to missed parental work, total costs per 100 patients were $27,100, $22,000, and $20,100, respectively. Total cost savings per 100 patients comparing the usual care arm with the medication dispensing arm was $7000.
This study suggests that uniform prescribing or dispensing of ICS at the time of ED visit for asthma may lead to a decreased number of ED visits and hospital admissions within 1 month and provides substantial cost-savings.
Asthma Inhalers (click to enlarge the image).
References:
A Cost-Effectiveness Analysis of Inhaled Corticosteroid Delivery for Children with Asthma in the Emergency Department. Annie Lintzenich Andrews, et al. The Journal of Pediatrics, Volume 161, Issue 5 , Pages 903-907.e1, November 2012
http://www.jpeds.com/article/PIIS002234761200532X/abstract
Image source: Image source: FDA and Wikipedia, public domain.
Interesting study, but the prices of medications quoted and used for cost calculations are seemingly ridiculously high. E.g. fluticasone 44mcg MDI allegedly costs $109 according to the paper. A fluticasone 50mcg MDI costs less than $20 here.
ReplyDeleteDo Americans get routinely ripped off to this extent for all medicines??