Cost-effectiveness of bivalirudin in pediatric ventricular assist devices

BACKGROUND

Despite recent data suggesting improved outcomes with bivalirudin vs heparin in pediatric Ventricular assist devices (VAD), higher costs remain a barrier. This study quantified trends in bivalirudin use and compared outcomes, resource utilization, and cost-effectiveness associated with bivalirudin vs heparin.

METHODS

Children age 0 to 6 year who received VAD from 2009 to 2021 were identified in Pediatric Health Information System. Bivalirudin use was evaluated using trend analysis and outcomes were compared using Fine-Gray subdistrubtion hazard ratios (SHR). Daily-level hospital costs were compared due to differences in length of stay. Cost-effectiveness was evaluated using incremental cost-effectiveness ratio (ICER).

RESULTS

Of 691 pediatric VAD recipients (median age 1 year, IQR 0-2), 304 (44%) received bivalirudin with 90% receiving bivalirudin in 2021 (trend p-value <0.01). Bivalirudin had lower hospital mortality (26% vs 32%; adjusted SHR 0.57, 95% CI 0.40-0.83) driven by lower VAD mortality (20% vs 27%; adjusted SHR 0.46, 95% CI 0.32-0.77) after adjusting for year, age, diagnosis, and center VAD volume. Post-VAD length of stay was longer for bivalirudin than heparin (median 91 vs 64 days, respectively, p < 0.001). Median daily-level costs were lower among bivalirudin (cost ratio 0.87, 95% CI 0.79-0.96) with higher pharmacy costs offset by lower imaging, laboratory, supply, and room/board costs. Estimated ICER for bivalirudin vs heparin was $61,192 per quality-adjusted life year gained with a range of $27,673 to $131,243.

CONCLUSIONS

Bivalirudin use significantly increased over the past decade and is now used in 90% young pediatric VAD recipients. Bivalirudin was associated with significantly lower hospital mortality and an ICER <$65,000, making it a cost-effective therapy for pediatric VAD recipients.

Doxycycline sclerotherapy for pediatric head and neck macrocystic lymphatic malformations: a case series and review of the literature

OBJECTIVE

(a) To evaluate the efficacy of doxycycline as a percutaneous sclerotherapy agent in pediatric head and neck macrocystic lymphatic malformations (LM) and (b) to review the literature with regard to recent developments in the treatment of lymphatic malformations using sclerotherapy.

METHODS

We reviewed the medical records and imaging studies of all patients who underwent percutaneous sclerotherapy of macrocystic LM of the head and neck at our institution between June 2005 and May 2010. All studies were reviewed and procedures performed by a single interventional neuroradiologist using computed tomography (CT) guidance. LM were individually cannulated, the contents aspirated, and then injected with doxycycline at concentrations of 10-20 mg/ml. Response to sclerotherapy was determined clinically.

RESULTS

Seven patients underwent a total of eight sclerotherapy treatments during the study period. Of the six patients with appropriate follow-up, 67% have experienced complete or near-complete clinical resolution of their LM (1243 days mean follow-up), while 33% have developed recurrent swelling after an initial response following a single doxycycline injection (53 days mean follow-up).

CONCLUSIONS

Our institutional results, in combination with recently published findings, support the moderate efficacy and excellent safety profile of percutaneous doxycycline sclerotherapy for macrocystic lymphatic malformations.

Dental caries status and treatment needs of children of fisher folk communities, residing in the coastal areas of Karnataka region, south India

OBJECTIVE

To assess the dental caries status and treatment needs of children belonging to the fisher folk communities.

METHOD

Two hundred and sixty-seven children up to the age of 14 years were examined using the World Health Organization (WHO) oral health assessment criteria, 1997.

RESULTS

The prevalence of dental caries was found to be high in the study population. The unmet treatment need was also high.

CONCLUSION

Further research is suggested in order to explore and identify the prevailing aetiological factors responsible for the current status.

Sugar consumption pattern of 13-year-old school children in Belgaum city, Karnataka

To determine the sugar consumption pattern of the school children in Belgaum city and to organize for a diet-counseling program. Easy availability of sugar containing food and high consumption of these sweets if continued unabated, the dental caries among children would become a major public health problem. In this instance, Dietary counseling can be just appropriate to inhibit the carious process. 342 school children aged 13 years, from four schools in Belgaum city participated in the study. The pattern of sugar consumption was assessed using a 4-day diet diary. Analysis was done according to the method described by Nizel and Papas (Nutrition in clinical dentistry, 1989, 277) and the variables were: the sweet score, At meal sugar exposure (AMSE), Between meal sugar exposure (BMSE) and Total sugar exposure (TSE). The mean, standard deviation and/or frequency were calculated for all variables. Student's t-test was used to statistically analyze the gender difference. The mean ± SD of the recorded variables were: sweet score 31 ± 12.78/day, AMSE 0.88 ± 0.33/day, BMSE 3.95 ± 0.87/day, and TSE 4.83 ± 0.96/day. No statistical significant gender difference with respect to the variables was observed. 'Tell Show And Do' Diet counseling session will perhaps have a greater impact as compared to the most common strategy of simply exhorting the children to eat less sugar.