Cost-effectiveness analysis of phenotypic-guided vs. guidelines-guided
bronchodilator therapy in viral bronchiolitis
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 in order to compare the cost-effectiveness of
phenotypic-guided versus guidelines-guided bronchodilator therapy in
infants with viral bronchiolitis. The effectiveness parameters and costs
of the model were obtained from electronic medical records. The main
outcome was avoidance of hospital admission after initial care in the
ED. 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 vs
US$263.46 average cost per patient) and a higher probability of
avoidance of hospital admission (0.7902 vs 0.7638), 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.