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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.
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Figure 1

jefferson buendia

and 2 more

jefferson buendia

and 1 more

Rationale, aims, and objectives Pharmacological treatment for bronchiolitis is primarily supportive because bronchodilators, steroids, and antibiotics, show little benefit. Clinical studies have suggested that nebulized 3% HS is useful for infants with bronchiolitis. The aim of this study was to evaluate the cost-effectiveness of the HS nebulized in infant bronchiolitis in a middle-income tropical country Methods A decision tree model was used to estimate the cost-effectiveness of the use of nebulized hypertonic saline (3-7%) compared with treatment without hypertonic saline nebulization (control) in bronchiolitis. Cost data were obtained from a retrospective study on bronchiolitis from tertiary centers in Rionegro, Colombia, while utilities were collected from the literature. The analysis was carried out from a societal perspective. Results The control strategy was dominated by HS nebulized group. The expected costs per patient were US$ 200 (CI 95% US$ 178- 222) in the HS nebulized group and US$ 240 (CI 95% US$ 213- 267) in controls. The expected utilities were 0.923 (CI 95% 0.922- 0.924) in the HS nebulized group and 0.91 (CI 95% 0.918- 0.920) in controls. Sensitivity analyses of parameters in the model showed that the cost-effectiveness of HS was only sensitive to the probability of hospitalization. Conclusion The strategy treatment without hypertonic saline nebulization was dominated by the strategy with HS nebulized in infants with bronchiolitis. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other tropical countries.