Emergency department-initiated home oxygen for viral bronchiolitis: A cost-effectiveness analysis

Document Type

Journal Article

Publication Date

5-27-2022

Journal

Pediatric pulmonology

DOI

10.1002/ppul.26018

Keywords

acute respiratory infections; low-to-middle income countries; poor outcomes; respiratory syncytial virus

Abstract

OBJECTIVE: The use of emergency department (ED)-initiated outpatient oxygen therapy has been considered to be a possible alternative to hospitalization for otherwise healthy-appearing, well-hydrated infants with uncomplicated disease. However, a formal economic evaluation of this treatment strategy is lacking. The aim of the present study was to compare the cost-effectiveness of ED-initiated outpatient oxygen therapy versus conventional inpatient hospitalization in infants with uncomplicated hypoxic bronchiolitis living in Bogota, the high-altitude capital city of Colombia, a middle-income country (MIC). METHODS: A decision analysis model was developed to estimate the cost-effectiveness of ED-initiated outpatient oxygen therapy versus hospitalization. The main outcome of the model was avoidance of admission to a high-dependency unit. RESULTS: Compared to hospitalization, ED-initiated outpatient oxygen therapy was associated with lower total costs (US$306.7 vs. US$638.7 average cost per patient) and a higher probability of avoidance of admission to a high-dependency unit (0.9528 vs. 0.8960), thus leading to dominance. The results were robust to deterministic and probabilistic sensitivity analyses. CONCLUSIONS: Our study suggests that in infants attending the ED with an uncomplicated hypoxic bronchiolitis episode in the city of Bogota, a high-altitude city, ED-initiated outpatient oxygen therapy is a dominant strategy compared to conventional inpatient hospitalization, because it involves a higher probability of avoidance of admission to a high-dependency unit, at lower total treatment costs.

Department

Pediatrics

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