A cost-effectiveness analysis of dexamethasone versus prednisone in pediatric acute asthma exacerbations.

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.