Objectives: The objective was to evaluate the cost-effectiveness of dexamethasone versus prednisone for the treatment of pediatric asthma exacerbations in the emergency department (ED).Methods: This was a cost-effectiveness analysis using a decision analysis model to compare two oral steroid options for pediatric asthma patients: 5 days of oral prednisone and 2 days of oral dexamethasone (with two dispensing possibilities: either a prescription for the second dose or the second dose dispensed at the time of ED discharge). Using estimates from published studies for rates of prescription filling, compliance, and steroid efficacy, the projected rates of ED relapse visits, hospitalizations within 7 to 10 days of the sentinel ED visit, direct costs, and indirect costs between the two arms were compared.Results: The rate of return to the ED per 100 patients within 7 to 10 days of the sentinel ED visit for the prednisone arm was 12, for the dexamethasone ⁄ prescription arm was 10, and for the dexamethasone ⁄ dispense arm was 8. Rates of hospitalization per 100 patients were 2.8, 2.4, and 1.9, respectively. Direct costs per 100 patients for each arm were $20,500, $17,200, and $13,900, respectively. Including indirect costs related to missed parental work, total costs per 100 patients were $22,000, $18,500, and $15,000, respectively. Total cost savings per 100 patients for the dexamethasone ⁄ prescription arm compared to the prednisone arm was $3,500 and for the dexamethasone ⁄ dispense arm compared to the prednisone arm was $7,000.Conclusions: This decision analysis model illustrates that use of 2 days of dexamethasone instead of 5 days of prednisone at the time of ED visit for asthma leads to a decreased number of ED visits and hospital admissions within 7 to 10 days of the sentinel ED visit and provides cost savings.
ACADEMIC EMERGENCY MEDICINE 2012; 19:943-948 ª 2012 by the Society for Academic Emergency MedicineA sthma is the most common chronic condition affecting children and a prominent chief complaint in pediatric emergency departments (EDs).1 Current standard of care in the ED includes systemic steroids for those patients who fail to respond promptly or completely to short-acting beta-agonist therapy.2 Systemic steroids have been shown to reduce airway inflammation, decrease rates of hospitalization, and decrease the number of repeat visits to the ED. [3][4][5][6] Traditionally, the most commonly prescribed systemic steroid regimen is a 5-day burst of oral prednisone ⁄ prednisolone. 4,5,7 However, several recent studies have shown that a 2-day course of dexamethasone has comparable efficacy to a 5-day course of prednisone ⁄ prednisolone for acute asthma management. 3,6,8,9 Compliance with oral systemic steroids after ED discharge is often a challenge for patients and families.
10Factors contributing to poor compliance include prolonged course of therapy, socioeconomic factors, underappreciation of severity of symptoms, and concern about medication side effects. 3,[10][11][12] Dexamethasone is an attract...