A cost-effectiveness analysis of inhaled corticosteroid delivery for children with asthma in the emergency department

J Pediatr. 2012 Nov;161(5):903-7. doi: 10.1016/j.jpeds.2012.05.015. Epub 2012 Jun 18.


Objective: To 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 design: We 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.

Results: The 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.

Conclusions: This 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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Inhalation*
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / economics*
  • Asthma / drug therapy*
  • Asthma / economics
  • Child
  • Cost-Benefit Analysis
  • Decision Trees
  • Emergency Service, Hospital / economics
  • Health Care Costs
  • Hospitalization / economics
  • Humans
  • Pediatrics / methods
  • Treatment Outcome


  • Adrenal Cortex Hormones