[Assessing the cost of the first episode of bronchiolitis]

[Methodological aspects of economic evaluation in pediatrics: illustration by RSV infection prophylaxis in the French setting]

The methodological approach of the economic evaluation of drugs in pediatrics is illustrated by the case study of the prophylaxis for RSV infections using palivizumab in the French setting. The indications for the reimbursement of this treatment have been restricted to premature children with bronchopulmonary dysplasia (BPD) or hemodynamically significant congenital-heart disease. A model was developed primarily using the results of the pivotal clinical studies on palivizumab. Unit costs were estimated (2006 values) in both societal and payer's perspectives. An assumption was made and discussed on the benefits of the prophylaxis on mortality. Based on the different data available and the estimated costs and benefits, different cost-effectiveness ratios (CERs) were estimated from both the society's and payer's points of view. A discount rate of 3% was applied to benefit. The CER obtained in the most unfavorable case is considered acceptable for the innovative-medical technologies in the French-healthcare system. Some of the parameters used by the model will be illustrated from the EPIPAGE study data from 2 of the 9 regions involved in this study: this evaluation suggests that the children not having an RSV infection during their 1st year of life will continue to require significantly fewer hospitalizations in the following years. These additional evaluations also suggest that the model overestimates the costs of the treatment with regard to the true medical situation. This could be explained by the model not using the children's exact weight or the real number of injections because the children had been discharged from the maternity ward based on their date of birth and the epidemic period. In spite of these factors, RSV prophylaxis using palivizumab in premature children with BPD or hemodynamically significant congenital-heart disease can be considered cost-effective in France.

Direct medical costs of bronchiolitis hospitalizations in the United States

OBJECTIVES

Although bronchiolitis is the leading cause of hospitalization for infants, there are limited data describing the epidemiology of bronchiolitis hospitalizations, and the associated cost is unknown. Our objective was to determine nationally representative estimates of the frequency of bronchiolitis hospitalizations and its associated costs.

PATIENTS AND METHODS

We analyzed the 2002 Health Care Utilization Project-National Inpatient Sample, a federal, stratified random survey of hospital discharges. For admissions age < 2 years with a discharge diagnosis of bronchiolitis (International Classification of Diseases, Ninth Revision, Clinical Modification, code 466.1), we used nationally representative weighted estimates to determine frequency and total hospital charges. Costs were estimated from reported charges by applying hospital-specific cost/charge ratios based on all-payer inpatient cost.

RESULTS

In 2002, an estimated 149,000 patients were hospitalized with bronchiolitis. Frequency of hospitalizations was higher among children age < 1 year of age, male gender, and nonwhite race. Mean length of stay was 3.3 days. Total annual costs for bronchiolitis-related hospitalizations were 543 million dollars, with a mean cost of 3799 dollars per hospitalization. Mean cost of bronchiolitis with a codiagnosis of pneumonia was 6191 dollars. In a multivariate analysis controlling for 3 confounding factors (including length of stay), cost per hospitalization was higher for children > or = 1 year and lower for those in the South versus Northeast.

CONCLUSIONS

Bronchiolitis admissions cost more than 500 million dollars annually. A codiagnosis of bronchiolitis and pneumonia almost doubles the cost of the hospitalization. Inpatient health care costs of bronchiolitis are higher than estimated previously and highlight the need for initiatives to safely reduce bronchiolitis hospitalizations and thereby decrease health care costs.

Impact de la conférence de consensus sur le traitement ambulatoire des bronchiolites du nourrisson

OBJECTIVE

To assess the impact of guidelines of the consensus conference in September 2000 on the ambulatory management of acute bronchiolitis in infants.

METHODS

Prospective multicenter study, in four hospitals in the North department in France, during three epidemic periods: the winter preceding the consensus conference and the two following winters. All the infants between 30 days and 2 years of age, admitted to an emergency care unit for a first or second episode of bronchiolitis were included. The infants' characteristics and ambulatory treatments prescribed were collected.

RESULTS

Six hundred thirty-eight infants were included: 169 before the conference and 469 after. Seventy-seven percent had consulted previously and a prescription had been drawn-up for 77%. There was no difference in the frequency of drug prescriptions or physiotherapy between the three periods. After the conferences, inhaled beta(2) agonists were still prescribed in 21% of cases, inhaled corticosteroids in 15%, oral corticosteroids in 34%, antibiotics in 53% and mucolytics in 54%. Physiotherapy was prescribed for 58% of the infants.

CONCLUSION

Two years after the consensus conference, the ambulatory treatment of bronchiolitis has no changed, corticosteroids, beta(2) agonists, antibiotics and mucolytics are still prescribed in excess. Further studies, within a few years, are required to reassess the application of the guidelines, not only in outpatient but also in inpatient management.

Infections nosocomiales virales dans un service de pédiatrie : l'exemple des gastroentérites à rotavirus et des bronchiolites à VRS

Nosocomial infections are a preoccupation in a pediatric hospital mainly during the winter with bronchiolitis and gastroenteritis epidemics. We have examined the risk factors of nosocomial infections.

MATERIAL AND METHODS

A prospective study was conducted between November, 1999 and March, 2000 in the infants units of the Le Havre hospital. We systematically listed the admissions and contacted the family after their discharge by phone. A geographic information system was implemented to display the epidemiological data; this software is able to illustrate the sectors at risk.

RESULTS

During the study, 687 infants were hospitalized of whom 458 for bronchiolitis and community-acquired gastroenteritis. Mean age was 5.4 months old. No nosocomial bronchiolitis occurred. Prevalence of nosocomial gastroenteritis was 10% (68 cases including nine after discharge). Infants with nosocomial infection were younger than those with community-acquired infection (6.6 months vs. 11.2 months, P < 0.01). The mean length of stay was longer in nosocomial infection (7.7 vs. 4.1 days, P < 0.05). Among the infants with bronchiolitis, 16% have developed nosocomial intestinal infections (RR = 2.65, IC: 1.59-4.4; P < 0.01). The geographic analysis pointed the area with nosocomial risk (bedroom without water, nearness of nurse office and games room).

CONCLUSION

Geographic information system is a part of the quality control system and may have some interaction effect on final decision making. Incidence of nosocomial infections showed the need for a prevention strategy in a pediatric hospital.