A Cost-Effectiveness Analysis of Inhaled Corticosteroid Delivery for Children with Asthma in the Emergency Department

ObjectiveTo determine the clinical effectiveness and cost-effectiveness of 3 inhaled corticosteroid (ICS) delivery options for children with asthma treated in and discharged from the emergency department (ED).Study designWe conducted cost-effectiveness analysis using a decision tree to compare 3 ED-based ICS delivery options: usual care (recommending outpatient follow-up), prescribe (uniformly prescribing ICS), and dispense (uniformly dispensing ICS). Accounting for expected follow-up rates, prescription filling, and medication compliance, we compared projected rates of ED relapse visits and hospitalizations within 1 month of ED visit across all 3 arms. Direct and indirect costs were compared.ResultsThe model predicts that the rate of return to ED per 100 patients within 1 month of the ED visit was 10.6 visits for the usual care arm, 9.4 visits for the prescription arm, and 8.4 visits for the medication-dispensing arm. Rates of hospitalization per 100 patients were 2.4, 2.2, and 1.9, respectively. Direct costs per 100 patients for each arm were $23 400, $20 800, and $19 100, respectively. Including indirect costs related to missed parental work, total costs per 100 patients were $27 100, $22 000, and $20 100, respectively. Total cost savings per 100 patients comparing the usual care arm with the medication dispensing arm was $7000.ConclusionsThis decision analysis model suggests that uniform prescribing or dispensing of ICS at the time of ED visit for asthma may lead to a decreased number of ED visits and hospital admissions within 1 month of the sentinel ED visit and provides a substantial cost-savings.