Oral Ondansetron Administration in Emergency Departments to Children with Gastroenteritis: An Economic Analysis

Freedman, Stephen B.; Steiner, Michael; Chan, Kevin

doi:10.1371/journal.pmed.1000350

Cited by 53 publications

(49 citation statements)

References 31 publications

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“…The aims of our work did not include a pharmacoeconomic analysis, but a previous study showed that the administration of oral ondansetron to children with dehydration and vomiting secondary to AGE led to significant monetary savings compared to a no-ondansetron policy [36]. Appropriate strategies are needed to successfully incorporate oral ondansetron into clinical practice in order to maximize its potential benefits [37].…”

Section: Discussionmentioning

confidence: 99%

Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial

et al. 2016

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The use of antiemetics for vomiting in acute gastroenteritis in children is still a matter of debate. We conducted a double-blind randomized trial to evaluate whether a single oral dose of ondansetron vs domperidone or placebo improves outcomes in children with gastroenteritis. After failure of initial oral rehydration administration, children aged 1–6 years admitted for gastroenteritis to the pediatric emergency departments of 15 hospitals in Italy were randomized to receive one oral dose of ondansetron (0.15 mg/kg) or domperidone (0.5 mg/kg) or placebo. The primary outcome was the percentage of children receiving nasogastric or intravenous rehydration. A p value of 0.014 was used to indicate statistical significance (and 98.6% CI were calculated) as a result of having carried out two interim analyses. 1,313 children were eligible for the first attempt with oral rehydration solution, which was successful for 832 (63.4%); 356 underwent randomization (the parents of 125 children did not give consent): 118 to placebo, 119 to domperidone, and 119 to ondansetron. Fourteen (11.8%) needed intravenous rehydration in the ondansetron group vs 30 (25.2%) and 34 (28.8%) in the domperidone and placebo groups, respectively. Ondansetron reduced the risk of intravenous rehydration by over 50%, both vs placebo (RR 0.41, 98.6% CI 0.20–0.83) and domperidone (RR 0.47, 98.6% CI 0.23–0.97). No differences for adverse events were seen among groups. In a context of emergency care, 6 out of 10 children aged 1–6 years with vomiting due to gastroenteritis and without severe dehydration can be managed effectively with administration of oral rehydration solution alone. In children who fail oral rehydration, a single oral dose of ondansetron reduces the need for intravenous rehydration and the percentage of children who continue to vomit, thereby facilitating the success of oral rehydration. Domperidone was not effective for the symptomatic treatment of vomiting during acute gastroenteritis.

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Section: Discussionmentioning

confidence: 99%

Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial

et al. 2016

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“…Estos resultados coinciden con análisis de costo-efectividad realizados para Estados Unidos, España, Canadá y Reino Unido [14][15][16][17], en los cuáles ondansetrón fue igualmente una estrategia dominante, recomendando su uso como práctica rutinaria. Freedman [14] reporta que su uso rutinario en los pacientes elegidos podría prevenir aproximadamente 29.246 inserciones de catéteres endovenosos y 7.220 hospitalizaciones al año en Estados Unidos, y al precio del momento, ahorraría 65,6 millones USD a la sociedad, y 61,1 millones USD a las empresas de aseguramiento en salud.…”

Section: Discussionunclassified

“…Freedman [14] reporta que su uso rutinario en los pacientes elegidos podría prevenir aproximadamente 29.246 inserciones de catéteres endovenosos y 7.220 hospitalizaciones al año en Estados Unidos, y al precio del momento, ahorraría 65,6 millones USD a la sociedad, y 61,1 millones USD a las empresas de aseguramiento en salud. Por su parte, el estudio de costo-efectividad desarrollado dentro de la GPC de diarrea y vómito del Reino Unido encontró que ondansetrón ahorraría (a precios de 2009), 51,68 £ por cada niño [16].…”

Section: Discussionunclassified

Análisis de costo efectividad de ondansetrón para el tratamiento del vómito en niños menores de cinco años con gastroenteritis en Colombia

Atehortúa

Flórez

Ceballos

et al. 2015

Value in Health Regional Issues

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“…An economic analysis reports that antiemetic use leads to significant monetary savings from decreased intravenous insertions and hospital admissions 5. Shortened stays in the ED can result in more patient satisfaction and decreased burden on staffing and wait times.…”

Section: Commentarymentioning

confidence: 99%

Oral ondansetron decreases vomiting, as well as the need for intravenous fluids and hospital admission, in children with acute gastroenteritis

Levine¹

2011

Evid Based Med

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Commentary on: Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.FedorowiczZDepartment of Emergency Medicine and Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York, New York, USAJagannathVADepartment of Emergency Medicine and Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York, New York, USACarterBDepartment of Emergency Medicine and Pediatrics, New York University School of Medicine/Bellevue Hospital Center, New York, New York, USACochrane Database Syst Rev20119

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Oral Ondansetron Administration in Emergency Departments to Children with Gastroenteritis: An Economic Analysis

Abstract: Stephen Freedman and colleagues performed a cost analysis of the routine administration of ondansetron in both the United States and Canada and show that its routine administration to eligible children in such settings could provide substantial benefit.

Cited by 53 publications

References 31 publications

Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial

Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial

Análisis de costo efectividad de ondansetrón para el tratamiento del vómito en niños menores de cinco años con gastroenteritis en Colombia

Oral ondansetron decreases vomiting, as well as the need for intravenous fluids and hospital admission, in children with acute gastroenteritis

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